Ultrasound

Introduction

Historically parathyroid localization was felt to be unnecessary and all one needed was a good surgeon. Recently there has been growing interest in parathyroid localization after biochemical confirmation of hyperparathyroidism. Preoperative localization is also very important in re-operative procedures for persistent disease and can be very helpful in the localization of ectopic parathyroid glands. This has been shown to lead to less morbidity, smaller scar, and shorter operative time. There are multiple localization modalities including traditional neck CT, 4-dimensional CT (4DCT), ultrasound (US), sestamibi nuclear medicine studies, and MRI. The majority of these have been discussed elsewhere in this book. This chapter deals primarily with ultrasound preoperative localization. Alcohol injection for the treatment of primary hyperparathyroidism is also addressed.

It is important to note that imaging studies should be used as an adjunct in the evaluation of primary hyperparathyroidism (PHPT). They should not be used for diagnostic purposes but should be employed only after a biochemical diagnosis has been achieved and other causes of hyperparathyroidism such as familial hypocalciuric hypercalcemia, vitamin-D deficiency, and renal insufficiency have been ruled out.