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| CASE REPORT |
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| Year : 2019 | Volume
: 65
| Issue : 4 | Page : 237-240 |
Retropharyngeal ectopic parathyroid adenoma versus lymph node: Problem solving with CT neck angiogram
PP Batchala, PK Rehm
Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA, USA
Correspondence Address:
P P Batchala
Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA
USA
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jpgm.JPGM_162_19
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.
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