Ektopik paratiroid dokusu ve paratiroid adenomu

Özet

Primer hiperparatiroidisi olan hastada paratiroid adenomu, özellikle beklenen bez yerinde bulunmadığında cerrahi öncesi lokalizasyon sorunu yaratır. Dört boyutlu BT, karakteristik kontrastlanma kinetiği ve yüksek alan çözünürlüğü ile ectopik veya tekrarlayan vakalarda adenomun lokalizasyonuna yardımcı olur. Arama yalnız tiroid arkasında bitmemeli; ektopik paratiroid dokusu retrofaringeal alanda da yerleşebilir. Ektopik odağın atlanması odak cerrahisinin başarısını düşürebilir ve persistan biyokimyasal hastalığa yol açabilir.

Faz ve pencere

Kontrastsız tanısal

Kontrastsız ve arteriyel fazlarda paratiroid lezyonları iyot içermeyen yumuşak doku odakları olarak görünürken, tiroid parankimi iyot içeriği nedeniyle daha yüksek atenüasyon gösterir; bu durum iki yapıyı ayırt etmede kullanılır.

Arteriyel tanısal

Adenomada belirgin arteriyel kontrastlanma görülebilir; kontrastlanma tiroidden daha yoğun olabilir veya tiroidden daha az yoğun başlayıp sonraki fazda daha fazla yıkanma gösterebilir.

Gecikmiş tanısal

Venöz/gecikmiş görüntüde adenoma kontrastının tiroid dokusuna kıyasla azalması hızlı yıkanma paternini destekler; tek başına kesin tanı koydurmaz.

Önerilen pencereler: Yumuşak doku (G 400 / M 40), Anjiyo (G 600 / M 150).

BT bulguları

• Tiroid arka yüzü, trakeoözofageal oluk ve karotis kılıfı boyunca oval, tiroid dışı yumuşak doku odağı aranır.
• Retrofaringeal yerleşimli odak, farinks arka duvarı ile prevertebral kaslar arasında veya tiroidin üst polü hizasında görülebilir.
• Kontrastsız fazda paratiroid lezyonlarının iyot içermemesi, tiroid parankiminin iyot içeriğine kıyasla daha düşük atenüasyon göstermesine neden olur; bu özellik kökenin ayırt edilmesini destekler.
• Arteriyel fazda yoğunlaşma ve gecikmiş fazda tiroidden daha belirgin kontrast kaybı tipik 4D-BT paternidir; adenomalarda patern değişken olabilir.
• Lezyon içi kalsifikasyon veya yağlanma sık değildir, ancak paratiroid adenomasını dışlamaz; faz davranışı ve komşu bezle ilişkisiyle birlikte değerlendirilir.
• Odağın tiroid, özofagus, longus colli kası ve lenf nodlarından ayrı olup olmadığı multiplanar kesitlerde gösterilir.

Normalde

Normal paratiroid bezleri çoğu kez BT'de ayrı bir nodül olarak seçilmez; tiroid arka kapsülü, trakeoözofageal oluk ve retrofaringeal yağ planları korunur. Aday odak ile komşu tiroid parankiminin kontrastsız ve kontrastlı fazlardaki atenüasyon farklarını ve yıkılma kinetiklerini karşılaştırarak, lezyonun tiroid dışı paratiroid dokusu olduğunu doğrula.

Ayırıcı tanı

Retrofaringeal lenf nodu

nodal zincir boyunca yerleşir; 4D kontrastlanma ve yıkanma paterni tipik paratiroid odağıyla örtüşmeyebilir.

Ekzofitik tiroid nodülü

tiroid parankimiyle devamlılık gösterir ve çoğu kez tiroidle benzer faz davranışı sergiler.

Zenker divertikülü, hipofarenks arka duvarından Killian dehisansı aracılığıyla gelişen bir farengoözofageal divertiküldür.

Schwannom

sinir hattı boyunca uzayan, daha büyük olduğunda komşu damarları yer değiştiren kitle oluşturabilir.

Ektopik tiroid dokusu

tiroidle benzer kontrastsız yoğunluk ve kontrastlanma davranışı gösterebilir; klinik biyokimya ve diğer görüntüleme ile birlikte yorumlanır.

Tuzaklar

• Küçük retrofaringeal odak tek kesitte lenf nodu gibi görünebilir; tiroid dışı yumuşak doku odağını fazlar boyunca aynı yerde izleyin.
• Paratiroid adenomasının arteriyel kontrastlanması her zaman tiroidden daha fazla değildir; gecikmiş fazdaki göreli yıkanmayı da inceleyin.
• İntratiroidal paratiroid lezyonları tipik tiroid nodüllerinin görüntüsüyle yakından örtüşebilir; çok fazlı kontrastlı BT ve fonksiyonel görüntüleme ile ayırt edici özellikleri aranmalıdır.

Kendini dene

1. Dört boyutlu BT'de paratiroid adenomu ile tiroid nodülünü ayırt etmede en güvenilir erken bulgu hangisidir?

   • Tiroidin iyot içeriği nedeniyle paratiroidden daha yüksek kontrastsız atenüasyon göstermesi
   • Paratiroidin venöz fazda tiroidden daha hızlı yıkılması
   • Lenf nodunun paratiroidden daha yüksek arteriyel boyanması
   • Divertikülün özofagus lümeniyle sürekli olması
   Cevabı göster

   Tiroidin iyot içeriği nedeniyle paratiroidden daha yüksek kontrastsız atenüasyon göstermesi. S87 kaynaklı: Tiroidin iyot içeriği, paratiroid lezyonlarına kıyasla kontrastsız fazda daha yüksek atenüasyon sağlar; bu özellik iki yapıyı ayırt etmede kullanılır.

2. Hipofarenks arka duvarındaki orta hatta, Killian dehisansı üzerinden özofagus lümeniyle bağlantılı bir divertikül izleniyor. En olası yapı hangisidir?

   • Zenker divertikülü
   • Paratiroid adenomu
   • Vagal schwannom
   • Metastatik lenf nodu
   Cevabı göster

   Zenker divertikülü. Divertikül tanısında özofagus lümeni ile bağlantı ve arka farenks duvarı yakın yeri belirleyicidir. Paratiroid adenomu, schwannom ve metastatik nod, özofagus lümenine açılan hava içeren kese oluşturmaz.

İlgili konular

• Lemierre sendromu ve septik internal juguler tromboflebit
• Makrokistik lenfatik malformasyon

Kaynaklar

Bu sayfadaki 34 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla tek tek karşılaştırıldı; 7 cümle bu karşılaştırmada düzeltildi (2026-10-08).

1. Parathyroid carcinoma in a nonorthotopic supraclavicular location: a 20-year coursepmc.ncbi.nlm.nih.gov
2. Ectopic anterior mediastinal parathyroid adenoma: A case reportpmc.ncbi.nlm.nih.gov
3. Case Series: Postoperative recurrent secondary hyperparathyroidism caused by ectopic submandibular parathyroid: 3 cases report and literature reviewpmc.ncbi.nlm.nih.gov
4. Diagnostic Contribution of SPECT/CT to Dual-Phase 99m Tc-MIBI Parathyroid Scintigraphy for Preoperative Localization in Primary Hyperparathyroidismpmc.ncbi.nlm.nih.gov
5. Integrin αvβ6 Expression in Parathyroid Adenomas and Adjacent Non-Neoplastic Parathyroid Tissue: Immunohistochemical Rationale for Integrin αvβ6-Targeted PET Imagingpmc.ncbi.nlm.nih.gov
6. Parathyroid 4D CT: What the Surgeon Wants to Know.pubmed.ncbi.nlm.nih.gov
7. [Ectopic hyperparathyroidism. Detection of mediastinal localization].pubmed.ncbi.nlm.nih.gov
8. Ectopic parathyroid glands and their anatomical, clinical and surgical implications.pubmed.ncbi.nlm.nih.gov
9. Ectopic Parathyroid Adenoma in Piriform Sinus: Case Report and Review of the Literature.pubmed.ncbi.nlm.nih.gov
10. New insight into ectopic thyroid glands between the neck and maxillofacial region from a 42-case study.pubmed.ncbi.nlm.nih.gov
11. Ectopic Parathyroid Adenoma: Surgical Correction and its Complication Management.pubmed.ncbi.nlm.nih.gov
12. Ectopic pure mediastinal parathyroid adenoma: A case report.pubmed.ncbi.nlm.nih.gov
13. Incidental Primary Intrathoracic Goiter: Dual-Isotope Scintigraphy and Early-MIBI SPECT/CT.pubmed.ncbi.nlm.nih.gov
14. CT-guided cryoablation of mediastinal parathyroid adenoma: an alternative to surgery.pubmed.ncbi.nlm.nih.gov
15. Recognizing Pinhole Parallax Error for Accurate Localization of Thyroid and Parathyroid Disease.pubmed.ncbi.nlm.nih.gov
16. Acute pancreatitis caused by an ectopic mediastinal parathyroid adenoma.pubmed.ncbi.nlm.nih.gov
17. Giant anterior mediastinal parathyroid adenoma.pubmed.ncbi.nlm.nih.gov
18. 11 C-Choline PET/CT for Detection and Localization of Parathyroid Adenomas.pubmed.ncbi.nlm.nih.gov
19. Surgical Management of Mediastinal Ectopic Parathyroids.pubmed.ncbi.nlm.nih.gov
20. Minimally invasive thoracoscopic resection of mediastinal ectopic parathyroid adenomas using robotic and video-assisted approaches: a three-case series.pubmed.ncbi.nlm.nih.gov
21. Incremental Value of Multimodality Imaging for Preoperative Localization in Primary Hyperparathyroidism: A Stepwise Strategy for Focused Parathyroidectomy.pubmed.ncbi.nlm.nih.gov
22. Ectopic anterior mediastinal parathyroid adenoma: A case report.pubmed.ncbi.nlm.nih.gov
23. The great masquerader: a case report of intrathyroidal hypofunctional normocalcemic parathyroid carcinoma mimicking a benign thyroid nodule.pubmed.ncbi.nlm.nih.gov
24. Intrathyroid parathyroid carcinoma and its diagnostic challenges ‒ case report and systematic review.pubmed.ncbi.nlm.nih.gov
25. Early Experience Utilizing 4D-CT Radiomic Features for Differentiation of Parathyroid Adenomas From Lymph Nodes and Thyroid Nodules.pubmed.ncbi.nlm.nih.gov
26. Ectopic parathyroid adenoma posterior to the trachea in the superior mediastinum causing refractory primary hyperparathyroidism: a case report.pubmed.ncbi.nlm.nih.gov
27. Case Report: An undescended intravagal parathyroid adenoma: a rare cause of refractory primary hyperparathyroidism and severe osteoporosis.pubmed.ncbi.nlm.nih.gov
28. Ectopic parathyroid adenoma: successful localization with 18F-fluorocholine PET/CT and parathyroid venous sampling in two cases.pubmed.ncbi.nlm.nih.gov
29. Concomitant parathyroid hormone-secreting oncocytic adrenocortical carcinoma and parathyroid adenoma.pubmed.ncbi.nlm.nih.gov
30. Case Series: Postoperative recurrent secondary hyperparathyroidism caused by ectopic submandibular parathyroid: 3 cases report and literature review.pubmed.ncbi.nlm.nih.gov
31. Spectral CT and Photon-counting Detector CT: Principles and Applications in Neuroradiology.pubmed.ncbi.nlm.nih.gov
32. Essentials for parathyroid imaging and intervention: what radiologists need to know.pubmed.ncbi.nlm.nih.gov
33. Optical coherence tomography for broad spectrum of thyroid carcinoma: a qualitative and quantitative analysis.pubmed.ncbi.nlm.nih.gov
34. Slice Level Classification of Parathyroid Adenoma Using Arterial Phase CT Images with Hybrid Light Attention Mechanism Based Residual Framework.pubmed.ncbi.nlm.nih.gov
35. Normo-hormonal primary hyperparathyroidism presenting with recurrent acute pancreatitis.pubmed.ncbi.nlm.nih.gov
36. The role of 4DCT in the localization of parathyroid adenomas in primary hyperparathyroidism: a retrospective cohort study.pubmed.ncbi.nlm.nih.gov
37. The Diagnostic Accuracy of [¹⁸F]Fluorocholine PET/CT for the Preoperative Localization of Hyperfunctioning Parathyroid Glands.pubmed.ncbi.nlm.nih.gov
38. Evaluating the preoperative diagnostic value of ^99mTc-MIBI/^99mTcO₄ ^- dual-isotope SPECT/CT fusion imaging and ultrasonography in suspected primary hyperparathyroidism.pubmed.ncbi.nlm.nih.gov
39. Early clinical experience with ⁶⁸Ga-Trivehexin PET/CT in parathyroid adenomas: a proof-of- concept imaging study.pubmed.ncbi.nlm.nih.gov
40. Incidence of Ectopic Parathyroid Glands in Primary, Secondary, and Tertiary Hyperparathyroidism.pubmed.ncbi.nlm.nih.gov
41. Ectopic parathyroid carcinoma coexisting with Graves' disease: A case report and literature review.pubmed.ncbi.nlm.nih.gov
42. Primary hyperparathyroidism due to dual parathyroid adenomas: one orthotopic, one intrathymic in ectopic cervical thymus.pubmed.ncbi.nlm.nih.gov
43. Dual-isotope subtraction scintigraphy and SPECT-CT for preoperative localization of parathyroid adenomas.pubmed.ncbi.nlm.nih.gov
44. Unmasking hidden culprits: The pivotal role of 4D CT in diagnosing parathyroid adenoma presenting as acute pancreatitis.pubmed.ncbi.nlm.nih.gov
45. Comparison of four-dimensional CT and Sestamibi SPECTCT in the localization management of primary hyperparathyroidism.pubmed.ncbi.nlm.nih.gov
46. Predicting Failure of Conventional Imaging in Primary Hyperparathyroidism: The Impact of Parathyroid Hormone Levels and Thyroid Nodules.pubmed.ncbi.nlm.nih.gov
47. Adrenohepatic Adhesion/Fusion Mimicking Hepatic Invasion: Two Cases of Benign Right Adrenal Lesions and a Review of the Literature.pubmed.ncbi.nlm.nih.gov
48. <i>CHEK2</i> germline gene variant in a patient with a somatotrophinoma and primary hyperparathyroidism: a novel MEN1-like syndrome?pubmed.ncbi.nlm.nih.gov
49. Cross-sectional imaging in cancers of the head and neck: how we review and report.pubmed.ncbi.nlm.nih.gov
50. Comparison of Ultrasonographic and Computed Tomographic Features of Parathyroid Glands in Canine Primary Hyperparathyroidism.pubmed.ncbi.nlm.nih.gov
51. Parathyroid autotransplantation: a phase-based framework for surgical decision-making.pubmed.ncbi.nlm.nih.gov
52. Parathyroid Imaging: Past, Present, and Future.pubmed.ncbi.nlm.nih.gov
53. Advances in the diagnosis and the management of primary hyperparathyroidism.pubmed.ncbi.nlm.nih.gov
54. Preoperative Localization for Primary Hyperparathyroidism: A Clinical Review.pubmed.ncbi.nlm.nih.gov
55. Opportunistic Assessment for Parathyroid Adenoma on CT: A Retrospective Cohort Study Evaluating Primary Hyperparathyroidism-Associated Morbidity Over 10 Years of Follow-Up.pubmed.ncbi.nlm.nih.gov
56. Paragangliomas Arising From the Laryngeal Paraganglia: Thyroid and Laryngeal Paragangliomas With Radiology-Pathology Correlation.pubmed.ncbi.nlm.nih.gov
57. Comprehensive comparison of salivary gland and cutaneous adnexal tumors: analogous versus discrepant clinical, terminological, histological, and molecular features : Part I.: Basic anatomy, overlapping topography, first series of related tumor entities.pubmed.ncbi.nlm.nih.gov
58. Multiple endocrine neoplasia type 5: emerging evidence and clinical perspectives.pubmed.ncbi.nlm.nih.gov
59. Use and utility of endocrine multidisciplinary tumour board: an appraisal from a tertiary centre.pubmed.ncbi.nlm.nih.gov
60. Software-Assisted Subtraction with Ultrasound-Correlated Interpretation Reduces Interpretive Ambiguity in Parathyroid Scintigraphy: A Preliminary Prospective Reporting Study.pubmed.ncbi.nlm.nih.gov
61. Hyperparathyroidism: current concepts in diagnosis and surgical treatment.pubmed.ncbi.nlm.nih.gov
62. Brain Metastases of Papillary Thyroid Carcinoma with Horner's Syndrome.pubmed.ncbi.nlm.nih.gov
63. Retropharyngeal and prevertebral spaces: anatomic imaging and diagnosis.pubmed.ncbi.nlm.nih.gov
64. An intrathyroidal cystic parathyroid adenoma localised with [¹⁸F]fluorocholine PET/CT in pregnancy.pubmed.ncbi.nlm.nih.gov
65. Up-to-Date Imaging for Parathyroid Tumor Localization in MEN1 Patients with Primary Hyperparathyroidism: When and Which Ones (A Narrative Pictorial Review).pubmed.ncbi.nlm.nih.gov
66. The Parathyroid Gland: An Overall Review of the Hidden Organ for Radiologists.pubmed.ncbi.nlm.nih.gov
67. Imaging Recommendations for Diagnosis and Management of Primary Parathyroid Pathologies: A Comprehensive Review.pubmed.ncbi.nlm.nih.gov
68. Complex Primary Hyperparathyroidism: Hereditary and Recurrent Disease.pubmed.ncbi.nlm.nih.gov
69. Multi-modality parathyroid imaging: A shifting paradigm.pubmed.ncbi.nlm.nih.gov
70. Human biomarker navigator.pubmed.ncbi.nlm.nih.gov
71. The SLC-ome of membrane transport: From molecular discovery to physiology and clinical applications.pubmed.ncbi.nlm.nih.gov
72. Radiosynthesis, Preclinical, and Clinical Positron Emission Tomography Studies of Carbon-11 Labeled Endogenous and Natural Exogenous Compounds.pubmed.ncbi.nlm.nih.gov
73. Molecular, Biochemical, and Bioimaging Markers of MEN Syndromes.pubmed.ncbi.nlm.nih.gov
74. Preoperative imaging strategies to optimize surgical treatment in primary hyperparathyroidism (pHPT).pubmed.ncbi.nlm.nih.gov
75. Traumatic retropharyngeal hematoma: A systematic review of reported cases.pubmed.ncbi.nlm.nih.gov
76. Unresectable Primary Enteric-Type Thymic Adenocarcinoma Treated With FOLFOX Chemotherapy: A Case Report.pubmed.ncbi.nlm.nih.gov
77. Spontaneous retropharyngeal haematoma with direct oral anticoagulant medication.pubmed.ncbi.nlm.nih.gov
78. Mediastinal parathyroid adenoma: diagnostic and therapeutic challenges.pubmed.ncbi.nlm.nih.gov
79. Diagnostic performance of 3T MRI preoperative localization of parathyroid adenomas in primary hyperparathyroidism.pubmed.ncbi.nlm.nih.gov
80. A Killian-Jamieson diverticulum potentially mimicking a thyroid nodule: A case report highlighting the cytology of a pharyngoesophageal diverticulum.pubmed.ncbi.nlm.nih.gov
81. Parathyroid carcinoma in a nonorthotopic supraclavicular location: a 20-year course.pubmed.ncbi.nlm.nih.gov
82. Integrin αvβ6 Expression in Parathyroid Adenomas and Adjacent Non-Neoplastic Parathyroid Tissue: Immunohistochemical Rationale for Integrin αvβ6-Targeted PET Imaging.pubmed.ncbi.nlm.nih.gov
83. A Pattern-based Imaging Approach to Pediatric Jaw Lesions.pubmed.ncbi.nlm.nih.gov
84. CT and MRI imaging of mass in the carotid space: a pictorial review.pubmed.ncbi.nlm.nih.gov
85. Preoperative Direct Puncture Embolization of Castleman Disease of the Parotid Gland: A Case Report.pubmed.ncbi.nlm.nih.gov
86. 4D CT-guided parathyroidectomy: improving operative efficiency in end-stage renal disease patients with medically refractory secondary hyperparathyroidism.pubmed.ncbi.nlm.nih.gov
87. Dual-Energy Parathyroid 4D-CT: Improved Discrimination of Parathyroid Lesions from Thyroid Tissue Using Noncontrast 40-keV Virtual Monoenergetic Images.pubmed.ncbi.nlm.nih.gov
88. Management of an hypopharyngeal fistula following open diverticulectomy for giant Zenker's diverticulum: a case report.pubmed.ncbi.nlm.nih.gov
89. Primary Repair of Traumatic Hypopharyngeal Perforation via Transcervical Endoscopic Approach in an Infant.pubmed.ncbi.nlm.nih.gov
90. Recurrent Cervical Esophageal Fistula and Retroesophageal Abscess Following Surgical Management of Zenker's Diverticulum.pubmed.ncbi.nlm.nih.gov
91. Parapharyngeal Schwannoma: Limitations Regarding Diagnosis and Surgical Intervention-A Case Report and Focused Literature Review.pubmed.ncbi.nlm.nih.gov
92. Post-styloid parapharyngeal neurogenic tumors: imaging-based prediction of nerve origin and clinical outcomes - a single-center retrospective case series.pubmed.ncbi.nlm.nih.gov
93. Personalized Management of Malignant and Non-Malignant Ectopic Mediastinal Thyroid: A Proposed 10-Item Algorithm Approach.pubmed.ncbi.nlm.nih.gov
94. International Harmonization of Nomenclature and Diagnostic Criteria (INHAND): Non-proliferative and Proliferative Lesions of the Non-human Primate ( M. fascicularis ).pubmed.ncbi.nlm.nih.gov
95. Patterns of injury and violence in Yaoundé Cameroon: an analysis of hospital data.pubmed.ncbi.nlm.nih.gov
96. The Predilection of Specific Diseases to Affect Different Sections of the Esophagus.pubmed.ncbi.nlm.nih.gov
97. Management and prognosis of iatrogenic perforations of the cervical oesophagus and hypopharynx.pubmed.ncbi.nlm.nih.gov
98. Esophageal diverticula: from diagnosis to therapeutic management-narrative review.pubmed.ncbi.nlm.nih.gov
99. Hypercalcemia episodes caused by ectopic parathyroid adenoma and subsequent gastrointestinal stromal tumor: A case report and literature review.pubmed.ncbi.nlm.nih.gov
100. Intrathyroidal oncocytic parathyroid adenoma in an adult: A diagnostic challenge - Case report.pubmed.ncbi.nlm.nih.gov
101. Limited additional value of dual-layer spectral 4DCT compared with conventional 4DCT for preoperative localization in primary hyperparathyroidism.pubmed.ncbi.nlm.nih.gov
102. Prototype of a Virtual Reality Simulator for Thyroidectomy: A Proof of Concept.pubmed.ncbi.nlm.nih.gov
103. Exploring the advantages of mixed reality technology in Robot-assisted laparoscopic partial adrenalectomy.pubmed.ncbi.nlm.nih.gov
104. Comparison of ultrasound-guided percutaneous radiofrequency ablation and reoperation for nerve-adjacent cervical lymph node recurrence of papillary thyroid carcinoma: a propensity score-matched study.pubmed.ncbi.nlm.nih.gov
105. Quantitative Evaluation of Image Quality Improvement and Reduced Radiation Output with Photon-Counting CT in 4D Parathyroid Imaging.pubmed.ncbi.nlm.nih.gov
106. A mediastinal eosinophilic adenoma misdiagnosed as an esophageal stromal tumor: A case report.pubmed.ncbi.nlm.nih.gov
107. Utilization of cardiopulmonary bypass for resection of a massive left retrotracheal thyroid goiter: a case report and review of literature at a tertiary care hospital in Saudi Arabia.pubmed.ncbi.nlm.nih.gov
108. Incidentally detected retropharyngeal cystic parathyroid adenoma in trauma imaging: A diagnostic challenge.pubmed.ncbi.nlm.nih.gov
109. Preoperative localization in primary hyperparathyroidism: a stepwise approach integrating PTH-FNA washout and second-line ¹⁸F-choline PET/CT.pubmed.ncbi.nlm.nih.gov
110. Large Cervical Branchial Cleft Cyst in Adulthood Revealed by Airway Symptoms.pubmed.ncbi.nlm.nih.gov
111. A cystic lesion adjacent to the cystic duct diagnosed as ectopic thyroid tissue: a laparoscopic case report.pubmed.ncbi.nlm.nih.gov
112. Peculiar Presentation of an Intrapericardial Ectopic Thyroid.pubmed.ncbi.nlm.nih.gov

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