Thyroid and Parathyroid Ultrasound and Ultrasound-Guided FNA by Daniel S. Duick Robert A. Levine & Mark A. Lupo

Author:Daniel S. Duick, Robert A. Levine & Mark A. Lupo
Language: eng
Format: epub
Publisher: Springer International Publishing, Cham

Indications and Procedure of ETOH Ablation

Surgery is the mainstay for the definitive treatment of PHPT. In an occasional patient, who is deemed high surgical risk, percutaneous ethanol ablation can be attempted. The procedure is performed as below.

The skin and subcutaneous tissue is anesthetized using 2 ml of lidocaine under guidance. Lidocaine infiltration is performed under vision, using US transducer along the facial planes anterior to the parathyroid lesion. Once lidocaine infiltration is complete, the lesion is entered with a 27 or 25 G needle that is loaded with 0.5–1 cm3 of alcohol. The alcohol is injected into the target lesion in question. Great care should be taken to avoid injection outside the lesion. This can result in tissue necrosis. Similarly, puncturing of the posterior or medial aspect of the capsule should be avoided altogether. The risk for injury to recurrent laryngeal nerve is greater in such situations. Patients sometimes complain of a twinge or dull ache for 5–10 min. The disappearance or the “pruning” of blood flow by Doppler predicts success of injection (Fig. 9.18). If blood flow into the gland is unaffected by the injection 5–10 min following the first injection, a second injection may be administered. Ethanol ablation can be effective in MEN 1 subjects who have recurrent primary hyperparathyroidism [33].

Figure 9.18Postinjection “pruning” of the vascular pedicle

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