Ectopic Parathyroid Adenoma Localized by Tc-99m Sestamibi SPECT/CT Localization Prior to Re-operation is Useful

We present a 31-year old male patient with primary hyperparathyroidism (PHPT), complicated by obstructive uropathy due to a staghorn calculus. He had minimally invasive right lower pole parathyroidectomy (MIP), following localization in the right lower pole of the parathyroid gland, on ultrasound. Postsurgical histology confirmed it to be a lymph node. The serum calcium and PTH levels remained elevated post-operative. Tc-99m methoxyisobutyl isonitrile (Sestamibi) planar imaging showed a focus of uptake superior to the upper pole of the right thyroid gland, that was localized lateral to the right true vocal cord on SPECT/CT. Post- operative histology confirmed a parathyroid adenoma.