CT-guided cryoablation of mediastinal parathyroid adenoma: an alternative to surgery

Primary hyperparathyroidism is most commonly caused by adenoma formation in one of the 4 parathyroid glands. The presence of ectopic parathyroid tissue is relatively common and can lead to difficulties in identification and treatment if affected by adenoma. This report describes the case of a 45-year-old female who presented 10 years status post thyroidectomy with symptomatic hyperparathyroidism and found to have ectopic parathyroid adenoma in the anterior mediastinum. Parathyroid scintigraphy with 99m-Technetium sestamibi and computed tomography were used for localization of the adenoma to a 1.9-centimeter para-aortic nodule. Computed tomography-guided transsternal cryoablation was subsequently performed for treatment, with intraoperative evaluation of serum parathyroid and calcium levels for confirmation. This case highlights that a sharp increase in parathyroid hormone immediately after cryoablation is not necessary for successful confirmation of the procedure. It additionally contributes to the growing literature on computed tomography-guided cryoablation as a legitimate alternative to surgery for treatment of ectopic parathyroid adenoma.