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Tracheal overlap: arteriographic sign of parathyroid adenomas in the posterior superior mediastinum.

Sometimes when panathynoid arteniognaphy is performed after an initial unsuccessful operation, such an obvious adenoma is demonstrated just below the thyroid lobe that one wonders how it could have been overbooked by the surgeon. This should suggest that the elusive adenoma is not in the neck but in the posterior superior mediastinium. Such a location can often be confirmed on the anteropostenior film by observing that the opacified gland overlaps the tracheal air column. We call this the tracheal overlap sign and find it very helpful in predicting a panaesophageal on paravertebral gland. In the past 2 years we have seen 10 surgically verified parathynoid glands in the posterior superior mediastinum. Eight of these (80%) demonstrated the tracheal overlap sign.