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Case Reports
. 2022 Jul 19;21(2):148-151.
doi: 10.1055/s-0042-1750337. eCollection 2022 Jun.

Incidental Primary Intrathoracic Goiter: Dual-Isotope Scintigraphy and Early-MIBI SPECT/CT

E Zamora  1 , S Ghandili  1 , M A Zamora  2 , K J Chun  1
Affiliations
Case Reports

Incidental Primary Intrathoracic Goiter: Dual-Isotope Scintigraphy and Early-MIBI SPECT/CT

E Zamora et al. World J Nucl Med. .

Abstract

Primary intrathoracic goiter is an uncommon congenital entity resulting from over decent ectopic thyroid tissue. As compared with secondary intrathoracic goiter, primary entities are discrete from orthotopic thyroid tissue and may lead to potentially serious complications such as malignancy and shortness of breath. Intrathoracic goiters have been described as showing mild or absent uptake of 99m Tc-pertechnetate on planar scintigraphy. We present an incidental primary intrathoracic goiter found in a patient undergoing evaluation with multimodal scintigraphy and early 99m Tc-sestamibi single-photon emission computed tomography/computed tomography (SPECT/CT) for localization of parathyroid adenomas. The mass was inconspicuous on TcO 4- scintigraphy but methoxyisobutylisonitrile-avid on early planar and SPECT/CT.

Keywords: MIBI; SPECT/CT; hyperparathyroidism; primary intrathoracic goiter; scintigraphy.

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Conflict of interest statement

Conflict of Interest None declared.

Figures

Fig. 1
Fig. 1
Dual-isotope planar scintigraphy with early ( A ) and delayed ( B ) 99m Tc-sestamibi (methoxyisobutylisonitrile, MIBI), and 99m Tc-pertechnetate (TcO 4- ) ( B ) of an elderly woman undergoing evaluation for hyperparathyroidism. Early-MIBI planar scintigraphy ( A ) showed a large moderately-avid mediastinal lesion ( arrowheads ) adjacent to the thyroid gland ( arrow ). Delayed images ( B ) showed equivocal areas of minimal retention in the mediastinal mass ( yellow arrows ); differential diagnoses included lymphoma, thymoma, and primary intrathoracic goiter. Early-MIBI planar scintigraphy ( A ) also showed a relatively thicker left lower thyroid pole that was discordant with TcO 4- images ( C ) and demonstrated minimal retention on delayed-MIBI ( B ), suggestive of a left lower thyroid pole localized parathyroid adenoma.
Fig. 2
Fig. 2
Early-methoxyisobutylisonitrile single-photon emission computed tomography/computed tomography (MIBI SPECT/CT) performed as part of the protocol for localizing parathyroid adenoma(s). Early-MIBI SPECT maximum intensity projection ( A ), and transcoronal fused SPECT/CT (B1) and contrast-enhanced CT images (B2) showed a large mediastinal mass discrete from the thyroid gland with heterogeneous uptake of MIBI ( arrowheads ). Additionally, there was relatively more intense activity in the left lower thyroid pole ( arrows ) that corresponded to the discordant uptake seen on TcO 4- planar images.
Fig. 3
Fig. 3
Transaxial fused and CTimages at the level of the lower thyroid gland show an MIBG-avid nodule posterior to the left thyroid lobe (A1-A2; arrows ). Transaxial fused and CT images of the chest showed a heterogeneously MIBG-avid mediastinal mass (B1, arrowheads ) with heterogeneous contrast enhancement (B2, arrowheads ). Post surgical changes are shown with removal of the left thyroid nodule (A3) and mediastinal mass (B3).
See this image and copyright information in PMC

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