1 Department of Diagnostic Imaging and 2 Department of Nephrology, Meir Hospital, Sapir Medical Center, 44281 Kfar Saba, Israel and 3 The Sackler Faculty of Medicine, Tel Aviv University, Israel
Correspondence and offprint requests to: Mauro Rathaus, Department of Nephrology, Meir Hospital, Sapir Medical Center, 44281 Kfar Saba, Israel. Email: rathaus{at}bezeqint.net
Keywords: calciphylaxis; hyperparathyroidism; recurrent; retro-oesophageal gland
A 77-year-old woman, treated with haemodialysis for 7 years, underwent neck exploration because of severe secondary hyperparathyroidism. Only three parathyroid glands were found and excised. Parathyroid hormone (PTH) levels decreased from 586 to 309 pg/ml (normal <65 pg/ml). One year later, PTH levels had returned to 506 pg/ml, and the CaxP product averaged 48 mg2/dl2. A necrotic skin lesion appeared on the lateral aspect of the left calf. Biopsy showed changes typical of calciphylaxis. A Tc-99m sestamibi scan demonstrated a zone of uptake near the thyroid isthmus, but ultrasound examination was negative. An MRI disclosed a suspected parathyroid gland in the retro-oesophageal space (Figure 1, arrow). A compression fracture of C6 was also seen (asterisk). The patient underwent a successful parathyroidectomy, PTH levels fell to 7 pg/ml and CaxP product to 50 mg2/dl2. The extended skin lesion completely healed 2 months after surgery.
|
Conflict of interest statement. None declared.