CLINICAL INDICATION: Hyperparathyroidism
SinaiMR#: DOB: Accession#: Date of Exam: Examination
RA CT NECK WITH WITHOUT CONTRAST
TECHNIQUE: CT of the neck was performed with and without contrast using dynamic parathyroid protocol. Precontrast images were obtained through the level of the thyroid, followed by dynamic postcontrast imaging from the base of the mandible to the carina. 2-D reformatted images were generated in axial, coronal and sagittal planes. Additional selected 2-D and 3-D reconstructions were generated by physician on an independent postprocessing workstation.
CONTRAST: Post-contrast imaging was obtained after intravenous infusion of 100 mL of Isovue-370.
Blood was drawn by a nurse in radiology for GFR assessment. Results: GFR > 60 mls/min/1.73m2
Creatinine: 0.6 mg/dL
Radiation dose estimate (Total exam DLP): 503.33 mGy-cm.
The thyroid gland demonstrates normal size and contours. There are bilateral thyroid nodules, including a heterogeneously enhancing 12 mm nodule in the anteromedial right thyroid lobe. This could be better characterized with ultrasound if clinically warranted.
There is an elongated focus of early enhancement within the right paraesophageal region, posterior to the right lower thyroid, which measures approximately 2 mm transverse x 17 mm craniocaudal. This is suggestive of a parathyroid adenoma in the given clinical setting.
There is a small 4 mm x 2 mm nodular focus inseparable from the posterior medial aspect of the left mid thyroid, in the left paraesophageal region, which is somewhat nonspecific and may reflect exophytic thyroid tissue/nodule, versus less likely a minimally prominent parathyroid gland.
There is fat attenuation involving the right tongue and floor of mouth which may reflect innervation changes and/or possibly postsurgical/posttreatment change, and correlation with clinical history is suggested. There is fullness of the right hypopharyngeal contour which slightly bulges into the vallecula in this region. Rounded hyperdense likely calcific focus is noted in the right paralaryngeal region with medialization of the right focal fold likely related to prior procedure. Please correlate with procedural history.
The submandibular glands are normal in density. No pathologic lymphadenopathy is seen within the neck. There are subcentimeter level 1 and level 2 lymph nodes, which are nonspecific.
The included lung apices are clear. Bone windows demonstrate no evidence of fracture or focal lesion.
2 mm x 17 mm elongated early enhancing focus within the right paraesophageal region, posterior to the right lower thyroid lobe, suggestive of a parathyroid adenoma.
4 mm x 2 mm small nodular focus along the posterior medial aspect of the left mid thyroid is nonspecific and may reflect exophytic thyroid tissue or nodule, versus possibly a minimally prominent parathyroid gland.
Bilateral thyroid nodules including a heterogeneously enhancing 12 mm right thyroid nodule as described. This may better characters with ultrasound if clinically warranted.
Right-sided tongue and laryngeal findings as described, are suboptimally assessed as this study is optimized for parathyroid localization and does not include the entire neck. Please correlate with clinical/procedural history.