Diagnostic ultrasound ( PDFDrive )

CHAPTER 20 The Parathyroid Glands 743
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FIG. 20.13 Ectopic Parathyroid Adenoma: Near Carotid Sheath. (A) Longitudinal sonogram of the right side of the neck shows an ectopic
undescended parathyroid adenoma (arrow) external to the carotid sheath, anterior to the common carotid artery (C). Ultrasound-guided biopsy
conirmed parathyroid tissue before surgical exploration. SG, Submandibular gland. (B) 99m Tc sestamibi coronal SPECT imaging shows a focal area
of increased activity in right superior lateral neck, which corresponds to the ectopic adenoma. SG, Salivary glands; T, thyroid. (C) Transverse and
(D) longitudinal sonograms in another patient show an ectopic left inferior adenoma located within the carotid sheath, posterior to the internal
jugular vein (J). Ultrasound-guided biopsy conirmed parathyroid tissue before surgical exploration. At surgery, the adenoma was adherent to the
vagus nerve. See also Video 20.12.
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FIG. 20.14 Graft-Dependent Hyperparathyroidism. (A) Longitudinal sonogram of left forearm shows an oval, 2-cm hypoechoic nodule (arrow)
resulting from hyperplasia of autotransplanted parathyroid tissue. M, Muscle. (B) Corresponding color Doppler low sonogram shows hypervascularity
of the hyperfunctioning parathyroid tissue in this patient with recurrent graft-dependent hyperparathyroidism.