Radio-guided thoracoscopic surgery with (99m)Tc-methoxy-isobutylisonitrile for treating an ectopic mediastinal parathyroid adenoma in an adolescent girl.

Here we report the case of a 17-year-old girl treated for an ectopic mediastinal parathyroid adenoma using (99m)Tc-methoxy-isobutyl-isonitrile (MIBI) and radio-guided thoracoscopic surgery. Her serum calcium and intact parathyroid hormone levels were elevated, and an anterior mediastinal tumor was noted on her chest computed tomography scan. At 2 h before surgery, the patient was given an injection of 370 MBq of (99m)Tc-MIBI. Because it was not possible visually to distinguish the tumor from the mature thymic tissue in which it was embedded, a search for the tumor was carried out using a gamma probe under thoracoscopy. Thereafter, the left thymus, including the radioactivity-positive tumor, was resected. We suggest that radio-guided thoracoscopic surgery with (99m)Tc-MIBI is an excellent procedure for treating ectopic mediastinal parathyroid adenomas embedded in the mature thymus of adolescents and young adults. This approach could be especially useful for young female patients, given its cosmetic advantage.