Diagnostic ultrasound ( PDFDrive )

754 PART III Small Parts, Carotid Artery, and Peripheral Vessel Sonography
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FIG. 20.24 Ethanol Ablation of Hyperplastic Autotransplanted Parathyroid Tissue. (A) Longitudinal color Doppler low sonogram of the
right neck shows a dominant vascular nodule that represents hyperfunctioning parathyroid tissue (arrow) in a patient with recurrent graft-dependent
hyperparathyroidism. SCM, Sternocleidomastoid muscle. (B) Transverse sonogram shows a needle tip (arrow) is placed within the nodule.
(C) Transverse sonogram shows ethanol is injected into portions of the nodule, which causes the tissues adjacent to the needle tip to become
transiently, brightly echogenic (arrow). (D) Subsequent to ethanol ablation, longitudinal color Doppler low sonogram shows decreased vascularity
in the injected nodule (arrow). See also Video 20.19.
hyperfunctioning of other untreated glands in the patient with
unrecognized multigland disease.
In theory, methods of thermal tissue ablation such as radiotherapy,
cryotherapy, and laser therapy, which have been used
to treat tumors elsewhere in the body, could also be applied to
treat parathyroid disease in the neck. hese methods are limited
at present by the lack of ablation devices that can precisely treat
very small amounts of tissue. In patients not considered surgical
candidates, there have been reports of successful treatment of
parathyroid adenomas using ultrasound-guided percutaneous
laser ablation. 156-158 However, as with ethanol ablation, the clinical
eicacy is transient and these methods of ablation are not deinitive
treatment of parathyroid disease.
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