Preliminary Diagnosis: Parathyroid Carcinoma
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 carcinoma.
Advantages
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Fast and portable imaging modality
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Does not expose patients to ionizing radiation
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May help guided percutaneous intervention
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Offers exquisite visualization of the surrounding vasculature
Disadvantages
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Mildly sensitive and poorly specific in diagnosing parathyroid carcinoma
III. What are the contraindications for the first-line imaging technique?
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No contraindications to ultrasound exist.
IV. What alternative imaging techniques are available?
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3-D CT of the parathyroid Bed
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Nuclear medicine Sestamibi scan
V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of parathyroid carcinoma.
3-D CT of the Parathyroid Bed
Advantages
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Highly sensitive and moderately specific in detailing a parathyroid abnormality
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Offers exquisite visualization of the surrounding soft tissues, vasculature, and osseous structures
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Helps guide treatment and therapy
Disadvantages
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Exposes patients to a large amount of ionizing radiation
Nuclear medicine Sestamibi scan
Advantages
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Highly sensitive and moderately specific in detailing, characterizing, and diagnosing a parathyroid carcinoma.
Disadvantages
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Offers limited detail and evaluation of the surrounding soft tissues, osseous structures, and vascular structures
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Limited in utility in guiding treatment and percutaneous intervention
VI. What are the contraindications for the alternative imaging techniques?
3-D CT of the Parathyroid Bed
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May be contraindicated in pregnant patients
Nuclear medicine Sestamibi scan
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May be contraindicated in pregnant patients or those breastfeeding
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