44 years old / female with chronic renal disease, on dialysis, with persistently high parathyroid hormone levels and low calcium, with calcium deposits on right shoulder labeled as myositis ossificans on x-ray, negative sestamibi scan.
With right shoulder deformity – due to calcium deposition on the soft tissue particularly on the muscles.
Calcifications on the soft tissue of right shoulder
Left parathyroids – hyperplastic (enlarged)
Right parathyroids – hyperplastic (enlarged)
The 4 hyperplastic parathyroids – largest at right upper – about 2 cm.
Neck incision for the parathyroidectomy
One parathyroid at the left lower chosen to be minced and transplanted – one half of the whole – about 3 mm.
Minced parathyroid placed in a pocket in the left sternocleidomastoid muscle (arms full of scars and with arteriovenous fistula)
Closure of pocket with silk suture to facilitate identification if there is a need to do a reduction of the parathyroid in the future
Resultant neck incisions – parathyroidectomy and parathyroid transplantation