Abstract
The typical sonomorphology of homogeneously hypoechoic texture of an enlarged parathyroid
gland (PG) is a reflection of uniform arrangement of the parathormone-producing chief cells.
A variable cellular arrangement, hemorrhage, fibrosis, and adipocytes cause heterogeneous
appearance. We describe a case of a 32-year-old male, a case of tertiary hyperparathyroidism,
with increased serum parathormone levels, hypercalcemia, and enlargement of all four
PGs, albeit with differing morphology. The left lower gland had two nodules, namely,
superior and inferior. The inferior nodule of the left lower gland had an echogenic
core surrounded by a sonolucent rim whereas the superior nodule was homogenously hyoechoic.
The left upper gland had an echopattern exactly reverse of the inferior nodule of
the left lower PG, i.e., hypoechoic gland surrounded by hyperechoic periphery. The
appearance of the right-sided glands was that of the superior nodule of the left lower
PG. On histopathology, the hypoechoic areas corresponded to numerous chief cells and
congested vessels whereas edema gave rise to an increase in echogenicity. This report
exemplifies atypical sonographic appearances of PG and their histopathologic correlation.
Keywords
Parathyroid adenoma - parathyroid glands - ultrasonography
