PMC4921174_01
99mTc-Sestamibi initial scan demonstrates asymmetric, mildly increased radiotracer uptake on the left side on the early images at 10 minutes (A), and persistent activity on the left side on the delayed images that is suspicious for an adenoma on delayed scan at 2.5 hrs (B).
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The initial 99mTc-Sestamibi parathyroid scan four days later demonstrated asymmetric, mildly increased radiotracer uptake on the left side on the early images; while the radiotracer activity was nearly completely washed out on the right side, there was persistent activity on the left side on the delayed images that was suspicious for a left-sided adenoma on both planar (Figs. 1A, B) and SPECT (single-photon emission computed tomography) images.
Sagittal images from three-dimensional CT scans show a clear line demarcating bilateral parathyroid adenomas (black arrows) on the right (A) and on the left (B) separating them from the thyroid gland (T).
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Careful correlation and retrospective review of a prior contrast-enhanced three-dimensional CT scan of the neck identified a clear margin between a large, teardrop-shaped soft-tissue mass posterior to the left lobe and another smaller, similar structure posterior to the mid to lower portion of the right lobe of the thyroid gland (Figs. 2A, B).