A 63-year-old woman with a history of primary hyperparathyroidism was evaluated for preoperative localization of a parathyroid adenoma. Because ultrasound of the thyroid was not diagnostic, Tc-99m sestamibi and Tc-99m pertechnetate imaging of the cervical region were performed. The delayed planar sestamibi scan showed a focal accumulation located in the region of the thyroid isthmus. In contrast, the Tc-99m pertechnetate scan did not show focal activity in this area. Therefore, a thyroidal explanation for the sestamibi accumulation could be excluded. A subsequent MRI confirmed a lesion between the esophagus and spine in anatomic correlation with the sestamibi scan. Sestamibi was injected before operation again for a gamma probendash;guided localization. With the aid of the probe, the surgeon was able to detect and remove a 0.5-g retroesophageal parathyroid adenoma.
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