SONOWORLD : parathyroid adenoma medullary nephrocalcinosis

Username

Password

171,982 Registered Members as of 02/21/2019.

JavaScript must be enabled in order for you to use Sonoworld.com in standard view. However, it seems JavaScript is either disabled or not supported by your browser. To use standard view, enable JavaScript by changing your browser options, then try again.

Thyroid/parathyroid » General

Parathyroid Adenoma causing medullary neprhocalcinosis

« Back to Listing

Author(s) :

Diana Gaitini, MD

Presentation A 39 years old woman presents at the clinic suffering from bone and abdominal pains. The patient has been diagnosed as having osteoporosis.

Caption: Transverse scan of the left lower neck

Description: Hypoechoic oval mass posterior to the left thyroid lobe, medial to the internal carotid artery.

Caption: Longitudinal scan of the lower left neck

Description: Hypoechoic oval mass posterior to the lower pole of left thyroid lobe.

Caption: Color Doppler and spectral display, left neck

Description: Within the mass a feeding artery with a low resistance flow is detected.

Caption: Longitudinal scan of the left flank

Description: Hyperechoic pyramids in left kidney

Caption: Longitudinal scan of the left flank

Description: Well demonstrated medullary hyperechogenicity in contrast with the adjacent normal echogenicity in the cortex of left kidney.

Caption: Longitudinal scan of the right flank

Description: The right kidney shows echogenic foci with acoustic shadowing compatible with stones in pyramidal tip or adjacent calyx and hyperechogenicity in the pyramidal base.

Caption: Transverse scan of the right flank, dual image, 2 levels

Description: These selected planes of the right kidney optimally illustrate the hyperechogenic medulla. Acoustic shadowing is incidentally noted in the right image.

Differential Diagnosis Medullary nephrocalcinosis
Renal tubular ectasia
Distal renal tubular acidosis
Hyperparathyroidism

Final Diagnosis Medullary neprhocalcinosis and calyx stone secondary to functional parathyroid adenoma

Discussion

Medullary neprhocalcinosis is defined as calcium deposits in the margin of renal pyramids. Stones may be seen in pyramid tip or in the adjacent calyx. On imaging- plain radiographs, sonograms, or CT- diffuse, fine, renal parenchymal calcifications are demonstrable. Calcification within the lumen of the collecting system represents nephrolithiasis.

Medullary neprhocalcinosis is in most of the cases secondary to hypercalcemic states: hyperparathyroidism, renal tubular acidosis (RTA), bone metastases, renal failure, vitamin D excess and sarcoidosis. Conditions associated with medullary nephrocalcinosis are: medullary sponge kidney, chronic pyelonephritis, renal papillary necrosis, sickle cell disease and Wilson’s disease.

In adults, 40% of cases of medullary nephrocalcinosis are attributed to hyperparathyroidism, and 20% are attributed to RTA. The remaining 40% are divided among the other multiple causes. Conversely, 5% of patients with hyperparathyroidism have nephrocalcinosis. The medullary type accounts for 95% of all nephrocalcinosis, whereas 5% represent cortical nephrocalcinosis

Case References

Krebs CA, Giyanani, VL, Eisenberg RL. Ultrasound atlas of disease processes. Norwalk, CT: Appleton & Lange, 1993: 378.
Gritzmann N, Koischwitz D, Rettenbacher T: Sonography of the thyroid and parathyroid glands. Radiol Clin North Am 2000 Sep; 38(5): 1131-45, xii[Medline].
Resnick D, Niwayama G Parathyroid disorders and renal osteodystrophies In: Resnick D. Diagnosis of bone and joint disorders. 3 ed, Philadelphia: WB Saunders, 1995: 2012-2075

Follow Up Adenoma of parathyroid gland confirmed by surgery. Medullary nephrocalcinosis confirmed on CT.

Other Cases in This Category

Thyroid/parathyroid >> General

Parathyroid adenoma
A 55 year old female presents with complaints of gastroesophageal reflux, crampy abdominal pain, depression and osteoporosis. Laboratory results showed a persistently elevated PTH levels.

Diffuse thyroiditis
A 25 year old femae presents with a one week history of a tender midline swelling of the neck. She also had complaints of palpitations and fine tremors of the hand. Laboratory features revealed ...

Papillary carcinoma of the thyroid with cervical nodal metastases
A 25 year old woman presented with firm right lateral neck swelling. She also had a six pound weight loss over a period of one month. An ultrasound of the neck was performed.

Papillary carcinoma of the thyroid
A 57 year old woman with left thyroid lobe enlargement. An ultrasound of the neck was performed.

Submandibular duct calculus
A young woman presented with pain in the right submandibular region. The patient said she could palpate something in her mouth since her pain had started.

Acute parotitis in a child
A 3-year-old girl presented with a very painful swollen right side of her face and neck and fever. This was the first episode. An ultrasound was performed.

Left parathyroid adenomas
A potential kidney donor was detected to have asymptomatic hypercalcemia. An ultrasound of the neck was performed.

Neonatal hyperthyroidism
This is the ultrasound scan of the neck in an infant with a history of maternal hyperthyroidism.

Right parathyroid adenoma
A young man presents with painless swelling on the right side of the neck of 15 days duration. An ultrasound of the neck was performed.

Submandibular gland sialolithiasis
A 9-year-old girl presents with recurrent painful swelling in the region of the left submandibular gland. On examination there was tender swelling with no signs of local inflammation. A focused ...

Parotid abscess with reactive lymphadenitis
This is the scan in a young kid with fever and a painful swelling of the right side of the face. She was treated with a 5-day- course of oral antibiotics; however there was minimal clinical ...

Subacute Granulomatous Thyroiditis, de Quervain's thyroiditis
A 39-year-old man presents with acute onset of pain in the thyroid region, exacerbated by turning the head swallowing. The pain radiates to the jaw.

Malignant Melanoma Metastasis to Parotid Gland
A 79-year-old with a history of cutaneous melanoma of the head is referred for ultrasound examination for bilateral swelling of the parotid glands.

Hashimoto's Thyroiditis
A 31 years old female presents overweight, fatigue, constipation and dry skin. Laboratory features revealed increased levels of TSH, decreased levels of T3, T4 and increased levels of TPO anti. A ...