Radio-guided surgery in recurrent renal hyperparathyroidism: report of a case.
BACKGROUND
It has been demonstrated that radio-guided surgery offers several advantages in treating primary hyperparathyroidism. Even if it is considered less helpful in renal hyperparathyroidism, it could be of tremendous advantage in the treatment of persistent or recurrent secondary hyperparathyroidism.


METHODS
We report a case of recurrent secondary hyperparathyroidism treated by the use of radio-guided surgery. The preoperative assessment consisting of ultrasonography, magnetic resonance imaging, and 99mTc-sestamibi scintigraphy identified a parathyroid in the upper mediastinum. The patient underwent a radio-guided neck re-exploration that allowed a rapid localization and excision of the ectopic gland, which was located in the anterosuperior mediastinum, in front of the trachea, between the innominant and the left common carotid artery.


RESULTS
The operative time was 45 minutes. The patient was discharged on the first postoperative day. A decrease in serum calcium and parathyroid hormone was observed subsequently. A follow-up of 6 months did not show any recurrence.


CONCLUSIONS
The case reported indicates that radio-guided surgery can help surgeons detect parathyroid tissue in selected cases of renal hyperparathyroidism.
Department of General Surgery, University of Ferrara, C.so Giovecca 203, 44100 Ferrara, Italy.
G
G
Navarra
S
S
Ascanelli
L
L
Feggi
P
P
Carcoforo
A
A
Turini
D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000000981:diagnostic imaging* / Q000601:surgery*; D007676:Kidney Failure, Chronic / Q000150:complications*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016105:Parathyroidectomy / Q000379:methods*; D011877:Radionuclide Imaging; D012008:Recurrence; D017256:Technetium Tc 99m Sestamibi; D014463:Ultrasonography
D017256:Technetium Tc 99m Sestamibi