Ectopic laryngeal parathyroid adenoma detected by SPECT sestamibi imaging

A 68-year-old woman presented with elevated serum calcium and elevated parathyroid hormone (PTH). Planar Tc-99m sestamibi imaging revealed an ectopic localization of radiopharmaceutical uptake in the neck to the left of the midline. Two surgical attempts failed to identify the parathyroid adenoma. SPECT Tc-99m sestamibi imaging revealed the location of the parathyroid adenoma near the midline of the neck in an anterior location. Angiography of the neck demonstrated a possible vascular mass in the larynx. Laryngoscopy while the patient was under general endotracheal anesthesia revealed a pedicled mass in the hypopharynx under the left arytenoid in the region of the left piriform sinus. After excision of this mass, the patient became normocalcemic. Pathologic examination of the excised tissue confirmed it was a parathyroid adenoma.