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Clinical Problem Solving: Radiology
March 2009

Radiology Quiz Case 1: Diagnosis

Author Affiliations
 

PATRICIA A.HUDGINSMD

Arch Otolaryngol Head Neck Surg. 2009;135(3):316-319. doi:10.1001/archoto.2008.551-b

The patient was initially treated conservatively with intravenous steroids and antibiotics as well as nebulized adrenaline, and her symptoms resolved within 5 days. There was evidence of an area of hemorrhage within the right inferior parathyroid gland, extending into the superior mediastinum. This finding was further supported by technicium 99m sestamibi SPECT imaging of the parathyroid glands, which demonstrated a right thyroid adenoma.

The contrast-enhanced axial CT images of the neck and superior mediastinum showed a nodule behind the right lobe of the thyroid gland (Figure 2, arrow) that contained a focus of high density. In the absence of unenhanced scans, the high-density focus might be interpreted as an enhancing thyroid nodule, but it was actually caused by an acute hemorrhage within a right inferior parathyroid adenoma. Surrounding the area of acute hemorrhage, there was a soft-tissue density mass posterior to the thyroid that extended to the superior mediastinum in the retropharangeal space. The soft-tissue mass in this case was a hematoma that was displacing the trachea anteriorly. Figure 4shows early (top row) and late (bottom row) technicium 99m sestamibi single-photon emission CT (SPECT) images demonstrating a focal area of tracer uptake and retention (arrows).

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