Multimodality imaging of a retrosternal parathyroid adenoma with multiple brown tumors

Brown tumors of hyperparathyroidism are rare but can mimic metastatic disease on many imaging modalities. We report the case of a patient presenting with symptomatic brown tumors of hyperparathyroidism due to a large retrosternal parathyroid adenoma, with histopathological correlation of both. The initial imaging findings on plain radiography, computed tomography, and bone scintigraphy were nonspecific and difficult to differentiate from the more common diagnosis of metastatic disease. Whole body sestamibi imaging however demonstrated increased uptake within both the mediastinal mass and multiple bone lesions leading to the correct diagnosis. We demonstrate modern multimodality imaging of this rare but treatable condition, and discuss the relevant literature.