Incidental Detection of Arteria Lusoria on Tc99m Sestamibi SPECT/ CT: A Vascular Surprise in Parathyroid Surgery Planning

Primary hyperparathyroidism (PHPT) due to parathyroid adenoma requires preoperative imaging for localisation, which may incidentally reveal vascular anomalies affecting surgery. A 62-year-old woman presented with recurrent epigastric pain, hypercalcemia (11.8 mg/dL), and elevated parathyroid hormone (PTH) (727 pg/mL), with ultrasound and sestamibi scan confirming right inferior parathyroid adenoma. SPECT/CT disclosed an aberrant right subclavian artery (arteria lusoria). Focused parathyroidectomy under cervical plexus block was performed after preoperative recognition of arteria lusoria, allowing cautious dissection in view of the possible association with nonrecurrent right laryngeal nerve (NRLN). Postoperative calcium/PTH normalised with symptom resolution. Arteria lusoria (~1% prevalence) associates with the nonrecurrent laryngeal nerve, mandating vigilant dissection. Routine cross-sectional imaging in PHPT aids anomaly detection for safer operative planning.