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https://doi.org/10.5005/jp-journals-10002-1459
World Journal of Endocrine Surgery
Volume 15 | Issue 2 | Year 2023

“Polar Vessel Sign”: Radiological Pointer of Parathyroid Adenoma


Abhishek Krishna1https://orcid.org/0000-0002-5063-2490, Roma Pradhan2, Ajay Suraj3, Kasturi Rangan4, Varun K Agarwal5, Mantasha Khan6, Shweta Yadav7, Amit Agarwal8

1,2,6–8Department of Endocrine and Breast Surgery, Medanta Hospital, Lucknow, Uttar Pradesh, India

3,4Department of Nuclear Medicine, Medanta Hospital, Lucknow, Uttar Pradesh, India

5Department of Radiology, Medanta Hospital, Lucknow, Uttar Pradesh, India

Corresponding Author: Roma Pradhan, Department of Endocrine and Breast Surgery, Medanta Hospital, Lucknow, Uttar Pradesh, India, Phone: +91 9732221166, e-mail: drromapradhan@gmail.com

Received on: 29 September 2023; Accepted on: 20 October 2023; Published on: 30 October 2023

ABSTRACT

A 49-year-old lady presented with recurrent renal stones and bone pains for 5 years. On evaluation, she was found to have raised serum calcium—11.2 mg/dL, intact parathyroid hormone (PTH), and low serum phosphorus with adequate 25-OH vitamin D. So, a biochemical diagnosis of primary hyperparathyroidism (PHPT) was established. Ultrasound of the neck showed a well-defined, oval-shaped, hypoechoic heterogeneous lesion (9.8 × 12.4 × 28.3 mm) noted at the posteroinferior side of the left thyroid lobe. The lesion shows peripheral vascularity and a feeding artery (polar vessel sign) suggestive of parathyroid adenoma (PA). “Polar vessel sign” is a characteristic ultrasound feature of PA and may help to identify the same in equivocal cases.

How to cite this article: Krishna A, Pradhan R, Suraj A, et al. “Polar Vessel Sign”: Radiological Pointer of Parathyroid Adenoma. World J Endoc Surg 2023;15(2):56–57.

Source of support: Nil

Conflict of interest: Dr Amit Agarwal and Dr Roma Pradhan are associated as the Editorial board members of this journal and this manuscript was subjected to this journal’s standard review procedures, with this peer review handled independently of these Editorial board members and their research group.

Patient consent statement: The author(s) have obtained written informed consent from the patient for publication of the case report details and related images.

Keywords: Parathyroid adenoma, Polar vessel sign, Primary hyperparathyroidism

A 49-year-old lady presented with recurrent renal stones and bone pains for 5 years. On evaluation, she was found to have the following serum biochemistry: serum calcium—11.2 mg/dL, serum phosphorus—2.2 mg/dL, 25-OH vitamin D—60 nmol/dL, and intact parathyroid hormone (PTH)—327.8 pg/mL. So, a biochemical diagnosis of primary hyperparathyroidism (PHPT) was established. Ultrasound of the neck showed a well-defined, oval-shaped, and hypoechoic heterogeneous lesion (9.8 × 12.4 × 28.3 mm) noted at the posteroinferior side of the left thyroid lobe. The lesion shows peripheral vascularity and a feeding artery (polar vessel sign) suggestive of parathyroid adenoma (PA) (Fig. 1). Technetium 99m sestamibi (Tc-99) myocardial perfusion imaging (MIBI), scan also showed a tracer avid soft tissue attenuation lesion (1 × 1.1 × 2.1 cm) posterior to left thyroid lobe extending from mid to lower pole—likely PA (Fig. 2). Since the lesion was concordant on two imaging modalities, a focused parathyroidectomy was done. Intraoperatively, the polar vessel feeding the adenoma was identified (Fig. 3). The specimen measured 2.5 × 1.5 cm and weighed 1.59 gm (Fig. 4).

Fig. 1: Parathyroid adenoma (PA) with “polar vessel sign” on ultrasonography

Fig. 2: Technetium 99m sestamibi (Tc-99) MIBI scan showing the MIBI avid lesion posterior to the left lobe of the thyroid gland

Fig. 3: Intraoperative photograph showing the polar vessel

Fig. 4: Excised PA specimen

Parathyroid adenomas (Pas) are not only hypervascular but also are suspended by a vascular pedicle consisting of an extrathyroidal feeding artery enveloped in fat.1 This “polar vessel sign” has been seen in 582 and 63%3 of the patients on ultrasonography in various studies. When the maximum diameter of the parathyroid gland is >1.35 cm, the sensitivity and specificity of polar vessel signs in predicting PA were 79 and 55.6% in a recent study.2 In our case, the size of the PA was 2.8 cm, and the polar vessel sign was clearly visible.

So, the “polar vessel sign” is a characteristic ultrasound feature of PA and may help to identify the same in equivocal cases.

ORCID

Abhishek Krishna https://orcid.org/0000-0002-5063-2490

REFERENCES

1. Wang C. The anatomic basis of parathyroid surgery. Ann Surg 1976;183(3):271–275. DOI: 10.1097/00000658-197603000-00010

2. Lu R, Zhao W, Yin L, et al. Efficacy of ultrasonography and Tc-99m MIBI SPECT/CT in preoperative localization of parathyroid adenomas causing primary hyperthyroidism. BMC Med Imaging 2021;21(1):87. DOI: 10.1186/s12880-021-00616-1

3. Wolf RJ, Cronan JJ, Monchik JM. Color Doppler sonography: an adjunctive technique in assessment of parathyroid adenomas. J Ultrasound Med 1994;13(4):303–308. DOI: 10.7863/jum.1994.13.4.303

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