The importance of multimodality imaging in diagnosing cystic parathyroid gland hyperplasia: a case report and systematic review

Background Parathyroid cysts account for a small percentage of parathyroid lesions and are more prevalent in females. Cystic parathyroid hyperplasia is exceptionally rare, with only two cases reported thus far. This case report provides the readers with the first multimodality imaging in cystic parathyroid hyperplasia as well as the authors’ first experience in using a 4D computed tomography (CT) scan in our institution while the systematic review will comprehensively search and present similar cases. Main text The literature search started and ended on August 4, 2024. We searched five academic databases: MEDLINE, Cochrane Library, Pubmed, Science Direct, and Google Scholar. The studied population was all patients with cystic parathyroid gland hyperplasia, confirmed by histopathology. A total of 205 articles were initially identified, out of which 29 duplicates were promptly eliminated, leaving 176 unique articles for screening. Following the evaluation of titles and abstracts, ultimately only two studies were included in the systematic review. A 61-year-old male presented with recurrent abdominal pain and weight loss. Ultrasound revealed a left neck mass, cystic. The laryngeal CT scan agreed with the ultrasound while the Technetium-99 sestamibi scan suggested a thyroid lesion. A 4D CT scan confirmed a lobulated cystic lesion in the left parathyroid region. The patient underwent successful surgery, and histopathology confirmed parathyroid hyperplasia with a pseudocyst appearance. Conclusions This case report presents the first imaging multimodality in cystic parathyroid hyperplasia while highlighting the rarity of this case, with two cases worldwide. In addition, this article describes our institution’s first experience with a 4D CT scan.