Double parathyroid adenoma and brown tumor--imaging with Tc99m MIBI: A case report.

Background: Dual phase parathyroid imaging with Tc99m methoxyisobutylisonitril (MIBI) is well known for the detection of parathyroid adenomas. We describe a unique case of brown tumor and double parathyroid adenomas in the neck. Case presentation: A 56-year-old female visited the Nuclear Medicine Department for parathyroid scanning. She underwent left parathyroidectomy 4 months ago and histopathology confirmed the diagnosis of parathyroid adenoma. However, her parathyroid hormone levels (2213 pg/ml) were consistently raised, even after the surgery. The patient was again referred to the Nuclear Medicine Department for parathyroid scanning. The second MIBI scan showed an abnormal area of radiotracer retention in the neck, near upper pole of right lobe of thyroid gland, favoring parathyroid adenoma with a focus of increased uptake in the chest on left side. Conclusion: This report emphasizes the importance of dual phase Tc99m MIBI scintigraphy in persistent hyperparathyroidisim following the parathyroid surgery. It also highlights possibility of double parathyroid adenoma or the ectopic parathyroid adenoma. [ABSTRACT FROM AUTHOR]