Radio-guided surgery in recurrent renal hyperparathyroidism: Report of a case

Background. It has been demonstrated that radio-guided surgery offers sever al advantages in treating primary hyperparathyroidism. Even if it is consid ered less helpful in renal hyperparathyroidism, it could be of tremendous a dvantage in the treatment of persistent or recurrent secondary hyperparathy roidism. Methods. We report a case of recurrent secondary hyperparathyroidism treate d by the use of radio-guided surgery. The preoperative assessment consistin g of ultrasonography, magnetic resonance imaging, and 99mTc-sestamibi scint igraphy identified a parathyroid in the upper mediastinum. The patient unde rwent 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 c ommon carotid artery. Results. The operative time was 45 minutes. The patient was discharged on t he first postoperative day. A decrease in serum calcium End parathyroid hor mone was observed subsequently. A follow-up of 6 months did not show any re currence. Conclusions. The case reported indicates that radio-guided surgery can help surgeons detect parathyroid tissue in selected cases of renal hyperparathy roidism. (C) 2000 John Wiley & Sons, Inc.