PMC7522540_01
Left Shoulder Xray showing the fractured clavicle (red arrow) and a humeral lesion (blue arrow).
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This is a case of 41 years old previously healthy male patient with unremarkable previous surgical or family history presented to ER for a left nondisplaced clavicular fracture after a mild fall down from his height that was diagnosed on standard Xray (Fig. 1).
Cervical CT scan with IV contrast marking the right parathyroidal lesion (yellow arrow).
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A large well delineated mass was seen on the right thoracic inlet extended posterior to and separated from the right thyroid gland, esophagus and trachea measuring 4.5 x 2.7 x 2.4 cm (Fig. 2).
Left shoulder MRI detailing the humeral lesion (orange arrow).
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Cervical and thorax MRI of was performed for further details showing more bones affected like the vertebras L1 and T12 suggestive of metastatic bone disease of unknown primary tumor with normal tendinous and muscular systems, left humeral head lesion (Fig. 3) and right lower cervical mass same described by CT scan, with no local invasion (Fig. 4A-C).
99 m Technitium sesstamibi scan with increased uptake at the right parathyroid gland (pink arrow), AP and Lateral Views.
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A Tc99 m Sestamibi scintigraphy (Fig. 5) showed a large right hyperfunctioning parathyroid adenoma, and no ectopic lesions.
A. Right Parathyroid gland specimen 5 x 2 x 3 cm (black arrow) attached to the right thyroid gland (gray arrow).. B. Transverse sectioning of the specimens in the anatomy-pathology lab, parathyroid (black arrow) and thyroid (gray arrow).
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The right lower parathyroid adenoma 5 x 2 x 3 cm weighing 30 g and thyroid gland were sent to pathology (Fig. 6A and B).