Preliminary Diagnosis: Parathyroid Adenoma
I. What imaging technique is first-line for this diagnosis?
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Ultrasound of the thyroid and parathyroid bed
II. Describe the advantages and disadvantages of this technique for diagnosis of parathyroid adenoma.
Advantages
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Highly portable and fast imaging modality.
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Does not expose patients to ionizing radiation
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May help guide treatment and biopsy
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Useful in evaluating the vascularity of a focal mass or other abnormality
Disadvantages
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Poorly sensitive and specific in evaluating for a parathyroid adenoma
III. What are the contraindications for the first-line imaging technique?
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No specific contraindications to ultrasound exist.
IV. What alternative imaging techniques are available?
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Nuclear medicine technetium 99 M Sestamibi imaging
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3-D parathyroid CT imaging
V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of parathyroid adenoma.
Nuclear medicine technetium 99 M Sestamibi imaging
Advantages
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Highly sensitive and specific in evaluating for a focal parathyroid adenoma
Disadvantages
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Does not offer detailed evaluation of the surrounding soft tissues and osseous structures
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May be contraindicated in pregnant patients and those breast feeding
3-D Parathyroid CT imaging
Advantages
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Offers exquisite detail of the surrounding soft tissues and osseous structures
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Offers exquisite detail of a parathyroid adenoma and characterizes a parathyroid adenoma in comparison to surrounding soft tissues
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Highly sensitive and specific in detecting and characterizing ectopic parathyroid adenomas
Disadvantages
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Exposes patients to large amounts of ionizing radiation
VI. What are the contraindications for the alternative imaging techniques?
Nuclear medicine technetium 99 M Sestamibi imaging
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May be contraindicated in pregnant patients and those breast feeding
3-D Parathyroid CT imaging
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May be contraindicated in pregnant patients
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