Sonographic Technique and Tips to Localize Tiny Parathyroids

Abstract

In this chapter, special attention is given to the surgically confirmed cases where a subcentimetre-sized parathyroid adenoma has been localized in a patient with primary hyperparathyroidism and the unique challenges involved in the localization (Rasbach et al. 1984). Clinical presentation in this category is usually with subclinical or asymptomatic hyperparathyroidism or with mild symptoms. Some patients may present with vague hypercalcaemic symptoms, and often, the clinical diagnosis is hidden and revealed subsequently on laboratory investigations. Scintigraphy imaging has limited accuracy in the detection of small adenomas (Alabdulkarim and Nassif 2010; Merlino et al. 2003). The technetium-99m scan, considered a gold standard for preoperative parathyroid gland localization, is often negative for the localization of parathyroids in the tiny subcentimetre-size range or gives equivocal findings. This chapter is important from an ultrasound imaging perspective, as, often, these tiny nodules can be well identified on ultrasound, despite being negative on nuclear scintigraphy.