Large carotid sheath parathyroid adenoma localized by Tc-99m sestamibi

The use of Tc-99m sestamibi to localize parathyroid adenomas is well established. Its greatest value is in the detection of adenomas in presurgical candidates to localize one or more adenomas in the parathyroid glands or to identify ectopic parathyroid adenomas. The authors describe a patient who had long-standing hyperparathyroidism with a history of end-stage renal disease, hypertension, and peptic ulcers with gastrointestinal bleeding. The scan showed a large ectopic parathyroid adenoma in the left retrosternocleidomastoid region. At surgery, the adenoma was located between the jugular vein and the carotid artery, within the carotid sheath.