January's Case of the Month

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Parathyroid Adenoma in a Geriatric Pomeranian

Sonographer: Kara Woody DVM

Patient Information:

Age:11 years
Gender: Neutered Male             
Breed: 
Pomeranian
Species: Canine


History:


Recent development of hypercalcemia. Patient is currently under therapy by oncologist for a transitional cell carcinoma of the bladder and is doing well.  


Laboratory Findings:

Hypercalcemia
 

Ultrasonographic Findings:

There is a homogenous severely hypoechoic rounded hypoechoic nodule (2.8x3.2mm) present in the caudal pole of the right thyroid gland. No other parathyroid glands are visualized in either thyroid gland.
 

Abdominal Ultrasound Interpretation:

Parathyroid Enlargement-DDx: diffuse hyperplasia vs. adenoma vs. adenomatous hyperplasia vs. adenocarcinoma

*Hyperplasia and neoplasia can overlap in size and cannot be differentiated with ultrasound alone (both look the same sonographically) but requires histopathology to definitively diagnose.


Outcome:

The mass was removed by a board certified surgeon and histopathology was performed which was consistent with a parathyroid adenoma with complete excision.  The patient’s hypercalcemia resolved after removal and he continues to do well.  
 

Discussion:

Parathyroid tumors are an important differential in hypercalcemic patients.  The majority of these tumors are benign adenomas and removal is curative. These tumors are often easily visualized with a cervical ultrasound.  Providing the surgeon with an exact location will greatly assist with surgical planning.

A transverse view of the parathyroid nodule located in the right thyroid gland. The heavily shadowing structure is a normal air-filled trachea.

A transverse view of the parathyroid nodule located in the right thyroid gland. The heavily shadowing structure is a normal air-filled trachea.

A sagittal view of the right thyroid gland showing the parathyroid nodule is located in the caudal pole.

A sagittal view of the right thyroid gland showing the parathyroid nodule is located in the caudal pole.

Happy patient celebrating his 12th birthday after his parathyroidectomy.

Happy patient celebrating his 12th birthday after his parathyroidectomy.

Special thanks to Colonial Animal Hospital for collaborating on this case.