Localization of parathyroid adenomas by cervical esophagram

By using a standardized method of cervical esophagraphy, parathyroid adenomas were successfully localized preoperatively in 19 of 20 consecutive patients with hyperparathyrodism. Two of the 19 patients had a second adenoma which was not demonstrated. The esophagrams were performed in the frontal projection with a 105-mm camera by utilizing rapid sequential filming. Film exposure was synchronized so that roentgenograms were obtained with the esophagus maximally distended. A persistent indentation of the esophagus present on multiple films was compatible with parathyroid enlargement. Our results suggest that cervical esophagrams are useful in the preoperative localization of parathyroid adenomas.