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Clinical Problem Solving: Radiology |

Radiology Quiz Case 1

Philip B. Zald, MD; Bobak Ghaheri, MD; Bronwyn Hamilton, MD; James Cohen, MD, PhD
Arch Otolaryngol Head Neck Surg. 2007;133(6):614. doi:10.1001/archotol.133.6.614.
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A 59-year-old woman presented to an outside institution with a history of renal stones, osteoporosis, and myalgias. Her serum calcium concentration was elevated at 11 mg/dL (2.75 mmol/L), with a simultaneous parathyroid hormone level (PTH) of 125 pg/mL (13 ng/L). Dual-energy x-ray absorbitometry scanning revealed T scores of –2.9 at the lumbosacral spine and –2.7 at the hip, which were decreased from measurements determined 5 years earlier. The patient's bone changes occurred despite biphosphonate therapy. A comprehensive head and neck examination and flexible endoscopy demonstrated no abnormalities. Technetium Tc 99m sestamibi imaging revealed an area of increased signal in the area posterior to the midpolar region of the left thyroid lobe (Figure 1). Parathyroid exploration revealed 2 normal-appearing glands, which were confirmed by biopsy on the right side. A single gland was identified and confirmed by biopsy on the left side. In light of the preoperative sestamibi scanning results, a left hemithyroidectomy was performed. After surgery, the patient remained hypercalcemic, with elevated serum PTH levels.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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