Costal brown tumor detected by dual-phase parathyroid imaging and SPECT-CT in primary hyperparathyroidism

A 58-year-old male with primary hyperparathyroidism underwent parathyroid scintigraphy to obtain presurgical localization of a suspected parathyroid adenoma. Increased Tc-99m sestamibi uptake was seen on dual-phase imaging in a focal area corresponding to the right inferior parathyroid. An incidental finding was the intense tracer uptake in the left thorax. Immediate SPECT-CT imaging located the uptake area in the third left rib; it was subsequently demonstrated to represent a brown tumor. Brown tumors, skeletal manifestations of hyperparathyroidism, have been incidentally detected by bone scintigraphy, more rarely by Tc-99m sestamibi parathyroid scintigraphy.