Berland, Todd

We report the case of a 54-year-old woman undergoing radioguided parathyroidectomy in whom four normal glands were identified on cervical exploration. The gamma probe was instrumental in guiding us to the adenoma in a fifth gland that was not visible and was localized to the parenchyma of the left lobe of the thyroid gland. Many surgeons do not advocate use of the gamma probe in minimally invasive parathyroidectomy and rely solely on focused exploration on the basis of a preoperative sestamibi scan and intraoperative rapid parathyroid hormone assays. This case, however, illustrates the utility of the gamma probe in parathyroid adenoma localization.

Increasingly, endovenous ablation of the greater saphenous vein (GSV) is used for the treatment of symptomatic varicose veins. The propagation of thrombus can result in a “tail of thrombus” within the common femoral vein (CFV). In two cases, patients were treated with low molecular weight heparin and re-imaged within 1 week. In both cases, complete resolution of the thrombus was confirmed, and anticoagulation was discontinued. Thrombus extension into the CFV after endovenous ablation may be safely treated with short-term anticoagulation and followed by duplex ultrasound. If unresolved, standard deep vein thrombosis anticoagulation is indicated.