Retropharyngeal ectopic parathyroid adenoma (PTA) is a rare entity. We present a case report of a patient with primary hyperparathyroidism (PHPT) who underwent dissection of the retropharyngeal space for excision of the PTA. It is imperative for an endocrine surgeon to be familiar with potential ectopic locations of PTA, especially when the results of routine first-line radiographic studies are equivocal. This awareness will avoid unsuccessful neck explorations and prepare the surgeon for a minimally invasive approach to excise the PTA. This case highlights the retropharyngeal space as an important ectopic site for PTA, underscores the limitations of ultrasound, and emphasizes the importance of newer diagnostic modalities such as technetium 99m sestamibi (MIBI) and 4D-computed tomography (4DCT) scans in easy preoperative identification of the location of ectopic PTAs.
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