Published in:
01-01-2014 | Image of the Month
Multiple skeletal lesions on FDG PET in severe primary hyperparathyroidism
Authors:
M. N. Kerstens, R. de Vries, J. T. M. Plukker, R. H. J. A. Slart, R. P. F. Dullaart
Published in:
European Journal of Nuclear Medicine and Molecular Imaging
|
Issue 1/2014
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Excerpt
A 55-year-old man presented with weight loss and diffuse bone pain. Strongly elevated concentrations of calcium (3.49 mmol/L, with normoalbuminuria) and parathyroid hormone (260 pmol/L) indicated primary hyperparathyroidism.
18F-FDG PET/CT scanning demonstrated uptake in the right upper and right lower pole of the thyroid region but also multiple
18F-FDG-avid osteolytic lesions, including the 7th cervical and 3rd lumbar vertebrae (a). Histopathological examination of a vertebral bone biopsy revealed a brown tumour. An enlarged left upper and right upper parathyroid gland were resected using a sestamibi gamma probe. In addition, a left-sided hemithyroidectomy with ipsilateral paratracheal nodal dissection was performed because of a suspected mass in the left thyroid lobe and enlarged lymph nodes [
1]. Pathological examination demonstrated a parathyroid adenoma but no carcinoma. Postoperative recovery was complicated by a severe hungry bone syndrome. Repeat
18F-FDG PET/CT scanning 4 months after surgery showed a marked reduction in the number of
18F-FDG-avid lesions in the skeleton (b). Also the intensity of
18F-FDG uptake in the remaining lesions was significantly lower. …