Ces radiol. 2018, 72(1):34-39 | DOI: 10.55095/CesRadiol2018/006

Disseminated malignacy incidentally detected on scintigraphic parathyroid imaging in haemodialysed patient suffering from calciphylaxisCase report

Eva Krčálová1,8, Jiří Horáček2,8, Sylvie Dusilová-Sulková3,8, Ioannis Svilias2, Eva Hovorková4, Markéta Nová4, Miroslav Ryba5, Lucie Turková6, Petr Dvořák6, Rudolf Repák7, Jiří Doležal1
1 Oddělení nukleární medicíny, Lékařská fakulta UK a Fakultní nemocnice, Hradec Králové
2 IV. interní hematologická klinika, Lékařská fakulta UK a Fakultní nemocnice, Hradec Králové
3 Hemodialyzační středisko, Fakultní nemocnice Hradec Králové a II. interní klinika, Lékařská fakulta UK, Hradec Králové
4 Fingerlandův ústav patologie, Lékařská fakulta UK a Fakultní nemocnice, Hradec Králové
5 Oddělení nefrologie a dialýzy, Krajská nemocnice Liberec
6 Radiologická klinika, Lékařská fakulta UK a Fakultní nemocnice, Hradec Králové
7 II. interní klinika, Lékařská fakulta UK a Fakultní nemocnice, Hradec Králové
8 Katedra interních oborů, Lékařská fakulta UK, Hradec Králové

A 74-year-old haemodialysed patient suffering from chronic renal failure and calciphylaxis, with kidney transplantation and graft rejection history, underwent parathyroid scan (dual-phase and subtracion protocol, using 99mTc-pertechnetate and 99mTc-metoxy-isobutyl-isonitrile, 99mTc-MIBI) due to elevated parathyroid hormone (PTH) levels. Parathyroid scan did not reveal parathyroid adenomas or hyperplasia; however a large cold nodule in the thyroid gland with 99mTc-MIBI uptake and two 99mTc-MIBI-avid pulmonary lesions (suggestive of metastasis) were detected. Thyroid gland nodule fine-needle aspiration cytology was benign, with undetectable PTH and normal calcitonin levels. Contrast-enhanced neck and chest CT confirmed clearly visible pulmonary and hilar metastatic lesions and disclosed an abnormal lymph node near the coeliac trunk and a soft-tissue lesion in pancreatic head, highly suggestive of neuroendocrine tumour. Surprisingly, their histology revealed renal cell carcinoma origin. Subsequent contrast-enhanced trunk CT detected a complex cyst (Bosniak III) in the left kidney upper pole, which could be the cystic kidney tumour.

Keywords: calciphylaxis, hyperparathyroidism, 99mTc-MIBI, SPECT/CT, renal tumour
Grants and funding:

Práce byla podpořena granty SVV 490050 a Progres Q 40-14.

Accepted: February 15, 2018; Published: March 1, 2018  Show citation

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Krčálová E, Horáček J, Dusilová-Sulková S, Svilias I, Hovorková E, Nová M, et al.. Disseminated malignacy incidentally detected on scintigraphic parathyroid imaging in haemodialysed patient suffering from calciphylaxis. Ces radiol. 2018;72(1):34-39. doi: 10.55095/CesRadiol2018/006.
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