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Fig. 2B —59-year-old man with primary hyperparathyroidism. Fused multiplanar SPECT-CT images localize uptake in upper chest to small nodule just above level of aortic arch (arrowheads). There was also a right inferior parathyroid adenoma (not shown). Accurate localization greatly aided surgical planning, and ectopic parathyroid adenoma was confirmed at surgery. Ectopic adenomas account for up to 20% of parathyroid adenomas. Note physiologic tracer uptake in submandibular glands (arrows).