In this radiology lecture, we review the ultrasound appearance of parathyroid adenoma!

Key teaching points include:

• Benign tumor of the parathyroid glands


• Most common cause of primary hyperparathyroidism: Elevated serum calcium and parathyroid hormone (PTH) levels


• Ultrasound: Solid, homogeneous and very hypoechoic. Oval or bean-shaped, long axis oriented craniocaudal. Hypervascular. Majority posterior and inferior to thyroid. Hyperechoic line often separates adenoma from adjacent thyroid. Atypical features: Cystic degeneration, calcification.


• Tc-99m sestamibi: Radiotracer uptake persisting on delayed 2-hour images. Taken up by both thyroid and parathyroid tissue, but washes out more rapidly from thyroid. Greater than 90% predictive value for preoperative localization of parathyroid adenoma. SPECT aids with anatomic localization


• Ectopic locations in up to 5%: Lower neck, mediastinum, retrotracheal/retroesophageal, carotid sheath and intrathyroidal (typically more homogeneous than thyroid nodules and have a linear interface with gland)


• Larger adenomas can be multilobulated


• “Polar vessel” sign: Enlarged feeding artery or draining vein terminating at parathyroid adenoma

To learn more about the Samsung RS85 Prestige ultrasound system, please visit: https://www.bostonimaging.com/rs85-prestige-ultrasound-system-4

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