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<p>An elderly lady with long-standing musculoskeletal pain and recurrent nephrolithiasis presented with hypercalcemia. Laboratory evaluation revealed PTH-dependent hypercalcemia. High resolution USG neck could not demonstrate definite parathyroid adenoma. Tc-99&#xa0;m sestamibi scintigraphy revealed a tracer-avid focus localized just posterior to the right inferior thyroid lobe. Four-dimensional CT scan identified an ovoid soft-tissue lesion (1.5 × 1&#xa0;cm) with enhancement similar to thyroid tissue in the arterial phase and an enlarged feeding artery entering the lesion—the characteristic "polar vessel sign"— confirming right inferior parathyroid adenoma. Right inferior parathyroidectomy under local anesthesia was performed successfully. Histopathology confirmed parathyroid adenoma. This case highlights the diagnostic utility of the polar vessel sign on 4D-CT in localizing occult parathyroid adenomas when conventional imaging yields equivocal results.</p>

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Polar Vessel Sign on 4D-CT Enabling Targeted Minimally Invasive Parathyroidectomy

  • 期刊论文

  • 发表日期：

    2026年5月28日

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  • Rajapriya Thirunavukkarasu,
  • Chitresh Kumar,
  • Rohit Barnabas,
  • Varun Bansal,
  • Preyander Singh Thakur

摘要

An elderly lady with long-standing musculoskeletal pain and recurrent nephrolithiasis presented with hypercalcemia. Laboratory evaluation revealed PTH-dependent hypercalcemia. High resolution USG neck could not demonstrate definite parathyroid adenoma. Tc-99 m sestamibi scintigraphy revealed a tracer-avid focus localized just posterior to the right inferior thyroid lobe. Four-dimensional CT scan identified an ovoid soft-tissue lesion (1.5 × 1 cm) with enhancement similar to thyroid tissue in the arterial phase and an enlarged feeding artery entering the lesion—the characteristic "polar vessel sign"— confirming right inferior parathyroid adenoma. Right inferior parathyroidectomy under local anesthesia was performed successfully. Histopathology confirmed parathyroid adenoma. This case highlights the diagnostic utility of the polar vessel sign on 4D-CT in localizing occult parathyroid adenomas when conventional imaging yields equivocal results.