<prompt> Kamli Rani, 75 year old-woman present with post myocardial infarction after 6 weeks mild CHF. There was past HO neck surgery for parathyroid adenoma 5 years ago, ECG shows slow atrial fibrillation. Serum Ca2 13.0 mgL and urinary Ca2 is 300 mg24 h. On examination there is small mass in the paratracheal position behind the right clavicle. Appropriate management at this time is:Repeat neck surgeryTreatment with Technitium-99Observation and repeat serum Ca2 in two monthsUltrasound-guided alcohol injection of mass  <response>: Patient is a case of recurrent hyperparathyroidism, as she was operated previously for parathyroid adenoma. In the sitting of recent myocardial infarction, CHF and atrial fibrillation, any operation carries a high risk. Ultrasound-guided alcohol injection in the mass is preferred in this setting, Ref: Harrison 19th edition Pgno: 2470 