Atlas of Sonography of Parathyroid

Description

This comprehensive atlas covers various common and uncommon cases of parathyroid disorders encountered in the day to day radiological practice. It serves as an illustrative database with numerous state of the art images of the diverse imaging features of parathyroid nodules and their correlation with various other imaging modalities. The book includes videos as well. It covers the typical and atypical ultrasound features of parathyroid nodules, their color Doppler findings and Sestamibi correlation. Size of the nodules detected range from small sub-centimeter nodules measuring between 6-15 mm, where often the sestamibi scan is negative, and diagnostic ultrasound scan is quite vital in management of these cases. The larger nodules range in size to be even larger than the thyroid gland and completely compressing and displacing the thyroid gland, which often leads to a missed diagnosis on initial imaging. Chapters cover tips and tricks in scanning along with various pitfalls. Additionally, it covers parathyroid nodules diagnosed on ultrasound in Sestamibi negative cases, localization of additional parathyroid nodules and parathyroid carcinoma. It covers correlation with surgical findings and includes histopathology images where relevant.  The book serves as a teaching tool for radiologists, ENT surgeons, head and neck surgeons, general surgeons, endocrinologists, nephrologists, gastroenterologists, medical oncologists and radiation oncologists involved in the management of parathyroid disorders.  Foreword Foreword Foreword Foreword Foreword Foreword Foreword Foreword Foreword Foreword Acknowledgements Contents About the Author Abbreviations 1: Introduction to Parathyroid Sonography 1.1 Anatomy and Embryology of Parathyroid Glands 1.2 Vascular Anatomy 1.3 Nerve Relations 1.4 Microscopic Anatomy 1.5 Embryological Anatomy 1.5.1 Origin, Migration and Eutopic Locations 1.6 Calcium Metabolism and Role of Parathyroid Hormone and Calcitonin 1.7 Hyperparathyroidism 1.8 Types of Hyperparathyroidism 1.9 Clinical Symptoms of Hyperparathyroidism 1.10 Biochemical Investigations: A Practical Approach to Hypercalcaemia 1.11 Approach to Hypercalcaemia 1.12 Imaging 1.12.1 Guiding Principles of Parathyroid Imaging 1.12.2 Parathyroid Scintigraphy: Tc-99m Sestamibi SPECT and SPECT/CT 1.12.3 Four-Dimensional Computed Tomography (4D CT) 1.12.4 Ultrasound of the Neck for Localization of the Parathyroid Glands 1.12.5 Patient Positioning for Neck Ultrasound 1.12.6 Ultrasound 1.12.6.1 Transducer Selection 1.12.6.2 Ultrasound Technique 1.12.7 Key Greyscale Ultrasound Features 1.12.8 Typical Parathyroid Adenoma 1.12.8.1 Key Colour Doppler Ultrasound Features 1.12.9 Role of Spectral Doppler in Parathyroid Evaluation 1.12.10 Role of Contrast-Enhanced Ultrasound (CEUS) in Parathyroid Evaluation 1.12.11 Role of Shear Wave Elastography in Parathyroid Nodule Evaluation 1.12.12 Differential Diagnosis of an Orthotopic Parathyroid Adenoma 1.12.12.1 Lymph Node 1.12.12.2 Blood Vessel 1.12.12.3 Thyroid Nodule 1.12.12.4 Sequestrated Thyroid Tissue 1.12.12.5 Internal Jugular Vein Thrombosis 1.12.12.6 Schwannoma of the Vagus Nerve in the Neck 1.12.12.7 Carotid Body Tumour 1.13 Medical Management 1.13.1 Calcium Supplementation/Restriction 1.14 Indications for Surgery 1.14.1 Skeletal Guidelines 1.14.2 Renal Guidelines 1.14.3 Histopathology 1.14.4 Parathyroid Adenoma 1.14.5 Parathyroid Hyperplasia 1.14.6 Parathyroid Carcinoma References 2: Sonography of a Typical Parathyroid Adenoma: Solitary Parathyroids as Seen on Ultrasound 2.1 Introduction 2.2 Case 1 2.2.1 Bio-Clinical Parameters 2.2.2 Technetium-99m Sestamibi Scan 2.2.3 Ultrasound Neck 2.2.4 Management 2.3 Case 2 2.3.1 Bio-Clinical Parameters 2.3.2 Imaging 2.3.3 Management 2.4 Case 3 2.4.1 Bio-Clinical Parameters 2.4.2 Management 2.5 Case 4 2.5.1 Clinical Details 2.5.2 Bio-Clinical Parameters 2.5.3 Technetium-99m Sestamibi Scan 2.5.4 Management 2.6 Case 5 2.6.1 Bio-Clinical Parameters 2.6.2 “Tc-99m Sestamibi” Scan Findings 2.6.3 Management 2.7 Case 6 2.7.1 Bio-Clinical Parameters 2.7.2 Ultrasound of the Neck for Parathyroid 2.7.3 Management 2.8 Case 7 2.8.1 Bio-Clinical Parameters 2.8.2 Ultrasound Neck 2.8.2.1 Findings 2.8.3 Management 2.9 Case 8 2.9.1 Bio-Clinical Parameters 2.9.2 Ultrasound Neck 2.9.3 Skeletal Survey 2.9.4 Management 2.10 Case 9 2.10.1 Bio-Clinical Parameters 2.10.2 Ultrasound Neck 2.10.3 Management 2.11 Case10 2.11.1 Bio-Clinical Parameters 2.11.2 Ultrasound Neck 2.11.3 Management 2.12 Case 11 2.12.1 Bio-Clinical Parameters 2.12.2 Management 2.13 Discussion 2.14 Management 2.15 Conclusion References 3: Atypical Sonographic Appearances of Enlarged Parathyroids 3.1 Introduction 3.2 Changes in the Shape of Adenoma 3.2.1 Case 1 3.2.1.1 Bio-Clinical Parameters 3.2.1.2 Imaging 3.2.1.3 Ultrasound Neck 3.2.1.4 Discussion of the Neck Ultrasound Findings 3.2.1.5 Management 3.2.2 Case 2 3.2.2.1 Bio-Clinical Parameters 3.2.2.2 Imaging 3.2.2.3 Ultrasound Neck 3.2.2.4 Management 3.2.3 Case 3 3.2.3.1 Bio-Clinical Parameters 3.2.3.2 Ultrasound Neck 3.2.3.3 Discussion of the Ultrasound Findings 3.2.3.4 Management 3.2.4 Discussion 3.3 Cystic Changes in Parathyroid Lesions 3.3.1 Case 4 3.3.1.1 Bio-Clinical Parameters 3.3.1.2 Imaging Technetium-99m Sestamibi Scan 3.3.1.3 Ultrasound Neck 3.3.1.4 Management 3.3.2 Case 5 3.3.2.1 Bio-Clinical Parameters 3.3.2.2 Management 3.3.2.3 Discussion: Parathyroid Cystic Changes and Parathyroid Cysts 3.3.3 Case 6 3.3.3.1 Bio-Clinical Parameters 3.3.3.2 Ultrasound Neck 3.3.3.3 Management 3.3.3.4 Discussion: Parathyroid Haemorrhage 3.4 Parathyroid Calcification 3.4.1 Case 7 3.4.1.1 Bio-Clinical Parameters 3.4.1.2 Ultrasound Neck 3.4.1.3 Management 3.4.1.4 Discussion: Parathyroid Calcifications 3.5 Altered Echotexture and Lobulations in Parathyroid Lesions 3.5.1 Case 8 3.5.1.1 Bio-Clinical Parameters 3.5.1.2 Imaging 3.5.1.3 Management 3.5.1.4 Discussion: Bilobed Parathyroid Adenoma 3.5.2 Case 9 3.5.2.1 Bio-Clinical Parameters 3.5.2.2 Ultrasound Neck 3.5.2.3 Management 3.5.3 Case 10 3.5.3.1 Bio-Clinical Parameters 3.5.3.2 Ultrasound 3.5.3.3 Management 3.5.4 Case 11 3.5.4.1 Bio-Clinical Parameters 3.5.4.2 Ultrasound Neck Findings 3.5.4.3 Management 3.6 Discussion 3.7 Conclusion References 4: Sonography of Large Parathyroid Adenomas 4.1 Introduction 4.2 Case 1 4.2.1 Bio-Clinical Parameters 4.2.2 Technetium-99m Sestamibi Scan 4.2.3 Ultrasound Neck Findings 4.2.4 Management 4.3 Case 2 4.3.1 Bio-Clinical Parameters 4.3.2 Ultrasound Neck 4.3.2.1 Findings 4.3.3 Management 4.3.4 Discussion 4.4 Case 3 4.4.1 Bio-Clinical Parameters 4.4.2 Findings: Technetium-99m sestamibi scan 4.4.3 Ultrasound Neck 4.4.3.1 Findings 4.4.4 Management 4.5 Case 4 4.5.1 Bio-Clinical Parameters 4.5.2 Technetium-99m Parathyroid scan 4.5.3 Ultrasound Neck 4.5.4 Management 4.6 Case 5 4.6.1 Bio-Clinical Parameters 4.6.2 99m-Tc Parathyroid Scan 4.6.3 Findings 4.6.4 Ultrasound Neck 4.6.5 Management 4.7 Case 6 4.7.1 Bio-Clinical Parameters 4.7.2 Ultrasound Neck 4.7.2.1 Findings 4.7.3 Management 4.8 Case 7 4.8.1 Bio-Clinical Parameters 4.8.2 Ultrasound Neck 4.8.2.1 Findings 4.8.3 Management 4.9 Case 8 4.9.1 Bio-Clinical Parameters 4.9.2 Ultrasound Neck 4.9.2.1 Findings 4.9.3 Management 4.10 Discussion References 5: Role of Ultrasound in Evaluation of Ectopic Parathyroid Glands 5.1 Introduction 5.2 Case 1 5.2.1 Bio-Clinical Parameters 5.2.2 Ultrasound Neck 5.2.2.1 Findings 5.2.3 Management 5.3 Case 2 5.3.1 Bio-Clinical Parameters 5.3.2 Management 5.4 Case 3 5.4.1 Bio-Clinical Parameters 5.4.2 Ultrasound Neck 5.4.3 Management 5.5 Case 4 5.5.1 Bio-Clinical Parameters 5.5.2 Ultrasound Neck 5.5.2.1 Findings 5.5.3 Management 5.6 Case 5 5.6.1 Bio-Clinical Parameters 5.6.2 Ultrasound Neck 5.6.3 Management 5.7 Case 6 5.7.1 Bio-Clinical Parameters 5.7.2 Ultrasound Neck 5.7.3 Management 5.8 Case 7 5.8.1 Bio-Clinical Parameters 5.8.2 Ultrasound Neck 5.8.2.1 Findings 5.8.3 Management 5.9 Case 8 5.9.1 Bio-Clinical Parameters 5.9.2 Ultrasound Neck 5.9.2.1 Findings 5.9.3 Management 5.10 Case 9 5.10.1 Bio-Clinical Parameters 5.10.2 Ultrasound Neck 5.10.2.1 Findings 5.10.3 Management 5.11 Case 10 5.11.1 Bio-Clinical Parameters 5.11.2 Ultrasound Neck 5.11.2.1 Findings 5.11.3 Management 5.12 Case 11 5.12.1 Bio-Clinical Parameters 5.12.2 Ultrasound Neck 5.12.2.1 Findings 5.12.3 Management 5.13 Case 12 5.13.1 Bio-Clinical Parameters 5.13.2 Ultrasound Neck 5.13.2.1 Findings 5.14 Discussion 5.14.1 Ectopic Parathyroids Along the Thymo-thymic Tract 5.14.2 Intrathyroidal Parathyroids References 6: Sonographic Technique and Tips to Localize Tiny Parathyroids 6.1 Introduction 6.1.1 Management 6.2 Case 1 6.2.1 Bio-Clinical Parameters 6.2.2 Ultrasound Neck 6.2.3 Management 6.3 Case 2 6.3.1 Bio-Clinical Parameters 6.3.2 Ultrasound Neck 6.3.2.1 Findings 6.3.3 Management 6.4 Case 3 6.4.1 Bio-Clinical Parameters 6.4.2 Ultrasound Neck 6.4.3 Management 6.5 Case 4 6.5.1 Bio-Clinical Parameters 6.5.2 Ultrasound Neck 6.5.2.1 Findings 6.5.3 Management 6.6 Case 5 6.6.1 Bio-Clinical Parameters 6.6.2 Ultrasound Neck 6.6.2.1 Findings 6.6.3 Management 6.7 Case 6 6.7.1 Bio-Clinical Parameters 6.7.2 Ultrasound Neck 6.7.3 Management 6.8 Discussion References 7: Sonography of Dual and Multiple Parathyroid Adenomas in Sporadic Primary Hyperparathyroidism 7.1 Introduction 7.1.1 Management 7.2 Case 1 7.2.1 Bio-Clinical Parameters 7.2.2 Ultrasound Neck 7.2.2.1 Findings Right Inferior Parathyroid Gland Left Superior Parathyroid Gland Left Inferior Parathyroid Gland 7.2.3 Management 7.3 Case 2 7.3.1 Bio-Clinical Parameters 7.3.2 Ultrasound Neck 7.3.2.1 Findings Left Inferior Parathyroid Right Superior Parathyroid Right Inferior Parathyroid 7.3.3 Management 7.4 Discussion References 8: Role of Sonography in Hyperparathyroidism in Chronic Kidney Disease and Post-Renal Transplant Recipients 8.1 Introduction 8.2 Pathophysiology of Hyperparathyroidism in Renal Disease 8.2.1 Management 8.3 Case 1 8.3.1 Clinical Details 8.3.1.1 Bio-Clinical Parameters 8.3.1.2 Ultrasound Neck Findings Right Inferior Parathyroid Right Superior Parathyroid Left Superior Parathyroid Left Inferior Parathyroid 8.3.2 Management 8.4 Case 2 8.4.1 Bio-Clinical Parameters 8.4.2 Ultrasound Neck 8.4.2.1 Right Inferior Parathyroid 8.4.2.2 Left Inferior Parathyroid 8.4.3 Management 8.5 Case 3 8.5.1 Bio-Clinical Parameters 8.5.2 Ultrasound Neck 8.5.3 Management 8.6 Case 4 8.6.1 Bio-Clinical Parameters 8.6.2 Ultrasound Neck 8.6.2.1 Findings Right Superior Parathyroid Right Inferior Parathyroid Left Superior Parathyroid 8.6.3 Management 8.7 Case 5 8.7.1 Bio-Clinical Parameters 8.7.2 Ultrasound Neck 8.7.2.1 Findings Right Superior Parathyroid Right Inferior Parathyroid Left Superior Parathyroid Left Inferior Parathyroid 8.7.3 Management 8.8 Case 6 8.8.1 Bio-Clinical Parameters 8.8.2 Ultrasound Neck 8.8.2.1 Findings Left Inferior Parathyroid Left Superior Parathyroid Right Inferior Parathyroid Right Superior Parathyroid 8.8.3 Management 8.9 Case 7 8.9.1 Bio-Clinical Parameters 8.9.2 Ultrasound Neck 8.9.3 Management 8.10 Case 8 8.10.1 Bio-Clinical Parameters 8.10.2 Discussion: Altered Echotexture of parathyroid nodules 8.10.3 Management 8.11 Case 9 8.11.1 Bio-Clinical Parameters 8.11.2 Ultrasound Neck 8.11.2.1 Findings Left Superior Parathyroid Left Inferior Parathyroid Right Inferior Parathyroid 8.11.3 Management 8.12 Conclusion References 9: Sonography Findings in Parathyroid Carcinoma and Heterogenous Parathyroids 9.1 Introduction 9.2 Case 1 9.2.1 Bio-Clinical Parameters 9.2.2 Ultrasound Neck 9.2.3 Management 9.2.4 Post Operative Histopathology Findings 9.3 Case 2 9.3.1 Bio-Clinical Parameters 9.3.2 Ultrasound 9.3.3 Management 9.4 Case 3 9.4.1 Bio-Clinical Parameters 9.4.2 Ultrasound 9.4.2.1 Findings 9.4.3 Management 9.5 Discussion References 10: Ultrasound Evaluation of Parathyroid Adenoma with Co-Existent Thyroid Pathology 10.1 Introduction 10.2 Case 1 10.2.1 Bio-Clinical Parameters 10.2.1.1 Findings 10.2.2 Ultrasound Neck 10.2.3 Management 10.2.4 Discussion 10.3 Case 2 10.3.1 Bio-Clinical Parameters 10.3.2 Ultrasound Neck 10.3.3 Management 10.4 Case 3 10.4.1 Bio-Clinical Parameters 10.4.2 Ultrasound Neck 10.4.3 Management 10.4.4 Discussion 10.5 Case 4 10.5.1 Bio-Clinical Parameters 10.5.2 Ultrasound Neck 10.5.3 Management 10.5.4 Discussion References 11: Ultrasound Essentials in MEN Syndromes and Familial Hyperparathyroidism 11.1 Introduction 11.2 Case 1 11.2.1 Bio-Clinical Parameters 11.2.2 Ultrasound Neck 11.2.2.1 Findings 11.2.3 Discussion 11.2.4 Management 11.3 Case 2 11.3.1 Bio-Clinical Parameters 11.3.2 Ultrasound Neck 11.3.2.1 Findings Right Superior Parathyroid Right Inferior Parathyroid Left Superior Parathyroid Left Inferior Parathyroid 11.3.3 Management 11.4 Case 3 11.4.1 Bio-Clinical Parameters 11.4.2 Ultrasound Neck 11.4.2.1 Findings Right Inferior Parathyroid Right Superior Parathyroid Left Inferior Parathyroid Left Superior Parathyroid 11.4.3 Management 11.5 Case 4 11.5.1 Bio-Clinical Parameters 11.5.2 Ultrasound Neck 11.5.2.1 Findings Right Superior Parathyroid Right Inferior Parathyroid Left Superior Parathyroid Left Inferior Parathyroid 11.5.3 Management 11.6 Discussion 11.7 Case 5 11.7.1 Bio Clinical Parameters 11.7.1.1 Radiograph of Both Hands and Skull Findings 11.7.1.2 99m-Technetium Parathyroid Scan 11.7.2 Ultrasound Neck 11.7.3 Management 11.8 Case 6 11.8.1 Bio Clinical Parameters 11.8.2 Ultrasound Neck 11.8.2.1 Findings 11.8.3 Management 11.9 Case 7 11.9.1 Bio Clinical Parameters 11.9.2 Ultrasound Neck 11.9.2.1 Right Inferior Parathyroid 11.9.2.2 Left Inferior Parathyroid 11.9.3 Management 11.9.4 Discussion 11.9.4.1 MEN1 11.9.4.2 MEN2 References 12: Essentials of Surgical Perspectives of Parathyroid Surgery 12.1 Indications for Exploration 12.2 Surgical Strategy and Approach to Exploration 12.3 Technique of Parathyroidectomy 12.3.1 Positioning of the Patient 12.3.2 Exploration of the Neck 12.3.3 Minimally Invasive Techniques 12.3.4 Closure of the Incision 12.3.5 Postoperative Care References Afterword