Mediastinal (Substernal) Parathyroid Adenoma in minimally invasive radioguided parathyroidectomy (MIRP)
This patient presented withhyperparathyroidism. A positive Technetium 99m-Sestamibiscan showed a right inferior parathyroid adenoma in the mediastinum, behind the upper sternum. The Neoprobe was used to confirm the location. In addition, to make the adenoma more visible, an intravenous infusion of methylene blue was administered. This dye stains the parathyroids with a deep blue color. A small 3 cm-incision was made just above the right clavicle. The parathyroid adenoma was very easily identified in the upper mediastinum because its blue color contrasted sharply with the surrounding fat and adjacent thymus.
Two hours after the administration of Tc 99 Sestamibi, the parathyroid scan shows an elongated "hot" density in the upper mediastinum, below the right thyroid lobe, indicating the presence of a parathyroid adenoma.
The parathyroid adenoma was readily visible because of the methylene blue uptake. It was pulled out of the mediastinum and removed from a small cervical skin incision.
This is a close-up of the mediastinal adenoma depicted in the previous picture.