Sonography of the abnormal parathyroid gland

In 80% to 90% of patients with primary hyperparathyroidism, a single parathyroid adenoma will be identified as the culprit, whereas the remaining 10% to 20% are caused by multiple adenomas, parathyroid hyperplasia, and rarely, parathyroid carcinoma. At the 2002 National Institute of Health consensus meeting, minimally invasive parathyroidectomy was endorsed as a promising and attractive alternative to total parathyroidectomy. Therefore, preoperative localization of the adenoma is critical in the clinical evaluation of the patient before surgical resection. Although adenomas less than 1 cm may be difficult to visualize sonographically, knowledge of typical imaging characteristics of parathyroid adenomas and use of special sonographic techniques will facilitate identification in most patients. Typical imaging characteristics of parathyroid adenomas include homogeneously hypoechoic echotexture on gray scale with an enlarged feeding artery and peripheral arc of vascularity seen on color and power Doppler. Proper neck extension, unilateral graded compression techniques, and patient swallowing will improve visualization of adenomas.