Introduction: In 85% of patients, the cause of Primary Hyperparathyroidism\n(PHPT) is an adenoma. Parathyroid adenoma localization is usually simple.\n96% of localizations prior to surgery are achieved with ultrasound and scintigraphy\ncombination. Difficulties can appear. If the gland is not located in a\ncervical position and has no uptake in scintigraphy but there is high suspition\nof an adenoma causing the PHPT, some extra tests should be considered.\nCase Report: We present a case of giant cystic mediastinal adenoma, a quite\nrare condition, which was diagnosed as a thyroid colloid cyst by ultrasound,\nand was not localized by scintigraphy. We report the CT scan and the magnetic\nresonance imaging (MRI) images that show the tumour. It was surgically\nresected by a cervical approach. After the excision, the patient recovered\nnormal levels of Calcium and Parathormone (PTH). Conclusion: We review\nliterature about cystic and mediastinal adenomas and diagnostic methods\nwhen the standard ones do not give an accurate localization diagnosis.
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