Abstract
We describe a case of a 56-year-old woman with primary hyperparathyroidism. 18F-Choline PET/MRI revealed incidental bilateral axillary lymphadenopathy with mild-moderate increased 18F-choline uptake. The patient had her first and third doses of COVID-19 vaccines from the left arm and second dose of vaccine from the right arm before PET examination.
Key Words: hyperparathyroidism, COVID vaccine, 18F-choline, PET/MRI, lymphadenopathy
FIGURE 1.
Hyperparathyroidism is a common entity in clinical practice; it is the third most common endocrinological disorder.1 The most common cause of primary hyperparathyroidism is parathyroid adenoma. Most of the adenomas occur sporadically.2 99mTc-MIBI scintigraphy and ultrasound yield over 85% sensitivity and specificity.3 If these tests occur to be negative, second-line imaging may be performed. 18F-Choline (FCH) PET yields over 90% sensitivity for parathyroid adenoma detection and superior to conventional imaging methods4–6; other than that, FCH has lower radiation exposure to patients and shorter acquisition time than Tc-MIBI.7,8 In this patient, PTH adenoma was detected at the left inferior of the thyroid gland (red arrow in A), which is surgically excised and pathologically proven afterward. Ipsilateral axillary lymphadenopathy can be incidentally detected after mRNA vaccination in FCH PET/CT9–12 and in FDG PET/CT.12,13 However, our patient had 2 inactivated COVID-19 vaccines (4 and 3 months before examination) and 1 mRNA vaccine (1 month before examination) before PET scan; her FCH PET images show bilateral axillary lymphadenopathy (yellow arrows), which is an unusual presentation. There was no other clinical cause for lymphadenopathy. MIP image (A), T1-LAVA MRI image (B), PET image (C), and PET/MRI fusion image (D).
Footnotes
Conflicts of interest and sources of funding: none declared.
Contributor Information
Fuad Aghazada, Email: fuad.aghazada@gmail.com.
Sertac Asa, Email: asa@iuc.edu.tr.
Rabia Lebriz Uslu Besli, Email: lebriz.uslu@iuc.edu.tr.
Kerim Sonmezoglu, Email: kerimsonmezoglu@yahoo.com.
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