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Title: Preoperative Localization of Mediastinal Parathyroid Adenoma with Intra-arterial Methylene Blue

Abstract

Ectopic parathyroid is found in 16% of patients with hyperparathyroidism. 2% of ectopic parathyroid adenomas are not accessible to standard cervical excision. In such cases, video-assisted thoracoscopic resection is the recommended definitive treatment. We present a case of mediastinal parathyroid adenoma localized preoperatively by injecting methylene blue within a branch of the internal mammary artery that is supplying the adenoma. Intra-arterial methylene blue injection facilitated visualization and resection of the adenoma. The preoperative intra-arterial infusion of methylene blue appears to be an effective and safe method for localization of ectopic mediastinal parathyroid adenomas and allows rapid identification during thoracoscopic resection.

Authors:
;  [1]; ; ;  [2];  [1]
  1. American University of Beirut Medical Center, Department of Diagnostic Radiology (Lebanon)
  2. American University of Beirut Medical Center, Department of General Surgery (Lebanon)
Publication Date:
OSTI Identifier:
22645180
Resource Type:
Journal Article
Resource Relation:
Journal Name: Cardiovascular and Interventional Radiology; Journal Volume: 40; Journal Issue: 6; Other Information: Copyright (c) 2017 Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE); http://www.springer-ny.com; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; ADENOMAS; ARTERIES; AVAILABILITY; HYPERPARATHYROIDISM; INFUSION; INJECTION; METHYLENE BLUE; PATIENTS

Citation Formats

Salman, Rida, Sebaaly, Mikhael G., Wehbe, Mohammad Rachad, Sfeir, Pierre, Khalife, Mohamad, and Al-Kutoubi, Aghiad, E-mail: mk00@aub.edu.lb. Preoperative Localization of Mediastinal Parathyroid Adenoma with Intra-arterial Methylene Blue. United States: N. p., 2017. Web. doi:10.1007/S00270-017-1578-4.
Salman, Rida, Sebaaly, Mikhael G., Wehbe, Mohammad Rachad, Sfeir, Pierre, Khalife, Mohamad, & Al-Kutoubi, Aghiad, E-mail: mk00@aub.edu.lb. Preoperative Localization of Mediastinal Parathyroid Adenoma with Intra-arterial Methylene Blue. United States. doi:10.1007/S00270-017-1578-4.
Salman, Rida, Sebaaly, Mikhael G., Wehbe, Mohammad Rachad, Sfeir, Pierre, Khalife, Mohamad, and Al-Kutoubi, Aghiad, E-mail: mk00@aub.edu.lb. Thu . "Preoperative Localization of Mediastinal Parathyroid Adenoma with Intra-arterial Methylene Blue". United States. doi:10.1007/S00270-017-1578-4.
@article{osti_22645180,
title = {Preoperative Localization of Mediastinal Parathyroid Adenoma with Intra-arterial Methylene Blue},
author = {Salman, Rida and Sebaaly, Mikhael G. and Wehbe, Mohammad Rachad and Sfeir, Pierre and Khalife, Mohamad and Al-Kutoubi, Aghiad, E-mail: mk00@aub.edu.lb},
abstractNote = {Ectopic parathyroid is found in 16% of patients with hyperparathyroidism. 2% of ectopic parathyroid adenomas are not accessible to standard cervical excision. In such cases, video-assisted thoracoscopic resection is the recommended definitive treatment. We present a case of mediastinal parathyroid adenoma localized preoperatively by injecting methylene blue within a branch of the internal mammary artery that is supplying the adenoma. Intra-arterial methylene blue injection facilitated visualization and resection of the adenoma. The preoperative intra-arterial infusion of methylene blue appears to be an effective and safe method for localization of ectopic mediastinal parathyroid adenomas and allows rapid identification during thoracoscopic resection.},
doi = {10.1007/S00270-017-1578-4},
journal = {Cardiovascular and Interventional Radiology},
number = 6,
volume = 40,
place = {United States},
year = {Thu Jun 15 00:00:00 EDT 2017},
month = {Thu Jun 15 00:00:00 EDT 2017}
}
  • The authors report, probably for the first time, a successful pre-operative localization of 7 mm intrathyroidal parathyroid adenoma which was successfully removed by using parathyroid imaging using a dual tracer (T1-201 and Tc-99m) and subtraction technique.
  • A new parathyroid scintigraphic localization study by a dual radioisotope technique using radioiodinated toluidine blue (RTB) for the parathyroids and /sup 99m/Tc for thyroid imaging is presented. A simple RTB labeling procedure achieving 99% tagging of the /sup 131/I-TB was used. The RTB was found to be a highly specific parathyroid radiotracer, consequently enabling superimposition of the delineated thyroid gland over the RTB avid parathyroid foci without a need for subtraction of the thyroid or vascular background. Forty-six patients with primary hyperparathyroidism underwent scintigraphic study prior to cervical (41 patients) or mediastinal (5 patients) exploration and 67 pathological parathyroid glandsmore » (34 adenomas and 33 hyperplasias) were excised. On follow-up, serum calcium level returned to normal in all patients. Correlation of the scintigraphic results with the surgical findings disclosed a sensitivity of 93%, with a specificity of 80% and an overall accuracy of 87%. This new simplified and specific RTB scintigraphic method justifies its use as a routine procedure for preoperative parathyroid scintigraphic localization in primary hyperparathyroidism.« less
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  • Intense diffuse uptake of Tc-99m-labeled methylene diphosphonate was seen in both lungs of a patient submitted to surgery for a primary parathyroid adenoma. Five scans performed over the 3 yr following the operation showed persistence of lung uptake despite restoration of normal blood calcium concentration. Mild chronic renal failure caused by the hypercalcemia also persisted postoperatively. The present case confirms that pulmonary uptake of bone tracer can occur asymptomatically when both hypercalcemia and renal failure are present. Lung uptake of a bone tracer probably reflects tissue deposition of hydroxyapatite rather than of amorphous structures. Correction of the hypercalcemia failed tomore » resolve the abnormal scan pictures.« less