Recurrent hyperparathyroidism secondary to parathyromatosis: clinical and imaging findings

Parathyromatosis, a condition in which hyperfunctioning parathyroid tissue is distributed throughout the neck, is a rare but challenging cause of recurrent hyperparathyroidism after parathyroidectomy. The purpose of this series is to describe the imaging appearance of parathyromatosis and the potential utility of sonographic localization before resection.

Imaging is routinely performed in an attempt to identify autonomous residual parathyroid glands in patients with recurrent hyperparathyroidism after parathyroidectomy. The sonographic and technetium Tc 99m sestamibi studies and the clinical records of 2 patients with recurrent hyperparathyroidism secondary to parathyromatosis were reviewed.

Color Doppler sonography easily identified scattered deep and superficial hypoechoic, hypervascular cervical nodules that did not conform to typical anatomic locations of parathyroid glands; the nodules corresponded to areas of delayed tracer uptake at Tc 99m sestamibi single-photon emission computed tomography. Intraoperative mapping of nodules aided the successful resection of widespread parathyromatosis in 1 patient.

Although the sonographic appearance of parathyromatosis may mimic disseminated cervical malignancy, a confident diagnosis of this rare entity may be made in the appropriate clinical setting. Sonography may also aid in directing the resection of disseminated parathyroid tissue in selected patients.