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Serum calcium (mg/dl) and PTH levels (pg/mL) during the course of her illness.
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The patient remained hypercalcemic (Fig. 1). Her serum calcium levels decreased significantly and she developed hungry bone syndrome (Fig. 1).
Nonenhanced phase (A), arterial phase (B) and delayed phase (C) axial images of the ectopic parathyroid adenoma (arrow). Results of PTH levels (pg/mL) from selective parathyroid venous sampling in each vein (D).
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An SVS PTH was performed, which indicated that the lesion was in the area of the left brachiocephalic vein (Fig. 2). A third operation was necessary, and a 4DCT of the neck was performed which revealed 2 parathyroid tissue lesions, one at the left lower neck near the left strap muscle just superomedial to the left internal jugular-brachiocephalic vein, and the other superomedial to the first (Fig. 2).