A 30-year-old woman had a history of chronic renal failure and was on regular hemodialysis. The patient had high levels of plasma parathyroid hormone, and ultrasonography of the neck demonstrated bilateral parathyroid hyperplasia. No nodular lesions in the anterior region of the neck were detected on physical examination. Dynamic and delayed parathyroid Tc-99m MIBI images were suggestive of a pericardial effusion. Planar Tc-99m MIBI myocardial scintigraphy was acquired in the three standard views, demonstrating a pericardial area of photon attenuation. Two-dimensional echocardiography confirmed the presence of large pericardial effusion.
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