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J Postgrad Med. 2019 Oct-Dec;65(4):237-240. doi: 10.4103/jpgm.JPGM_162_19.

Retropharyngeal ectopic parathyroid adenoma versus lymph node: Problem solving with CT neck angiogram.

Author information

1
Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA, USA.

Abstract

A 66-year-old female underwent preoperative evaluation for primary hyperparathyroidism. Ultrasound (US) neck and technetium (Tc)-99m-sestamibi planar scintigraphy were negative, but single photon emission computed tomography/computed tomography (SPECT/CT) demonstrated a tracer-avid retropharyngeal nodule compatible with parathyroid adenoma (PTA). A retrospective review of CT neck angiogram (CTA) and neck magnetic resonance imaging (MRI) performed 4 months earlier for stroke evaluation revealed arterial phase hyperenhancing retropharyngeal tissue, which had been dismissed as a nonpathological lymph node. "Polar vessel sign" seen in two-thirds of PTA was also present on retrospective review of the CTA. The concordant findings between SPECT/CT and CTA were indicative of a solitary undescended ectopic PTA in the retropharyngeal space, an uncommon location. A successful surgical cure was achieved after minimally invasive parathyroidectomy. This case highlights the retropharyngeal space as an important ectopic site of PTA, limitation of US, and Tc-99m-sestamibi planar scintigraphy in identifying retropharyngeal PTA. We also discuss the role of CT and MRI and the challenge in differentiating retropharyngeal PTA from a lymph node.

KEYWORDS:

Ectopic; Tc-99m-sestamibi scan; parathyroid adenoma; retropharyngeal

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