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Intraoperative Parathyroid Ultrasound

  • Ryan J. Li
  • Lisa A. OrloffEmail author
Chapter

Abstract

Localization studies have an important role in the assessment of patients with hyperparathyroidism. After a biochemical diagnosis of hyperparathyroidism is made, the utilization of real-time ultrasonography for precision treatment planning has become increasingly common amongst parathyroid surgeons. Characterization of pathologic parathyroid glands within the context of the surrounding anatomy is essential to plan a surgical approach, and to counsel the patient on treatment options. Preoperative ultrasound may direct the clinician towards or away from immediate surgical intervention. For example, in early or asymptomatic cases of hyperparathyroidism, a non-localizing sestamibi scan may be followed by ultrasound that does not reveal parathyroid pathology. The clinician may recommend additional localization and diagnostic studies, and postpone surgery. In another scenario, concomitant thyroid pathology may be identified on preoperative ultrasound and receive the appropriate evaluation before surgery is planned. The principles of ultrasound apply to the intraoperative setting as well—ultrasound immediately prior to skin incision can enhance surgical strategy. In this chapter we discuss the application of ultrasound technology in the preoperative and intraoperative management of parathyroid disease.

Keywords

Ultrasound Ultrasound Doppler Parathyroid surgery Hyperparathyroidism Head and neck imaging Parathyroid adenoma Parathyroid hyperplasia 

Supplementary material

Video 23.1

Simple sweep in transverse plane following right common carotid artery inferiorly to where it meets right subclavian artery at bifurcation from innominate artery (WMV 4914 kb)

Video 23.2

Sagittal-view power Doppler demonstrating increased and polar vascularity of parathyroid adenoma (middle arrow) in relation to thyroid (superior to adenoma, left arrow) and lymph node (inferior to adenoma, right arrow), in a patient with coexisting Hashimoto’s thyroiditis and central compartment lymphadenopathy (WMV 2575 kb)

Video 23.3

Transverse view in same patient as Video 23.2, showing increased and polar vascularity of parathyroid adenoma compared to hypovascularity of lymph node (parathyroid = upper arrow, lymph node = lower arrow) (WMV 4240 kb)

Video 23.4

Sagittal-view power Doppler demonstrating polar vascularity of small right inferior parathyroid adenoma (WMV 1146 kb)

Video 23.5

Ultrasound sweep from inferior to superior and back in transverse plane to visualize a parathyroid adenoma in the context of regional anatomy (large left inferior parathyroid adenoma deep/posterior to a relatively small left thyroid lobe) (WMV 8625 kb)

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Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  1. 1.Department of Otolaryngology/Head & Neck SurgeryOregon Health & Science UniversityPortlandUSA
  2. 2.Otolaryngology-Head & Neck SurgeryStanford University Medical CenterStanfordUSA

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