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A female patient in her 60s was referred for evaluation of primary hyperparathyroidism. Her medical history includes osteoporosis, left nephrectomy for renal carcinoma and right mastectomy followed by chemotherapy for breast cancer. Laboratory results confirmed parathyroid hormone-dependent hypercalcaemia. An ultrasound revealed no lesions suggestive of parathyroid disease, and a 99mTc-sestamibi scintigraphy did not show areas of increased activity. A CT scan revealed a hypodense, heterogeneous lesion (48 × 29 × 22 mm) in the cervical region, extending into the superior mediastinum, inferior to the right thyroid lobe, posterior and lateral to the trachea, displacing the oesophagus leftward, suggestive of necrotic adenopathy or oesophageal duplication cyst ( figure 1). A second CT scan raised the hypothesis of an enlarged parathyroid. An upper endoscopic ultrasound was performed, revealing a cystic lesion with echogenic content and smooth, well-defined margins. The lesion had the representation of all three layers of the gastrointestinal tract, suggestive of an oesophageal duplication cyst (figure 2). A biopsy was not performed due to the risk of iatrogenic complications. Subsequently, an 11C-Choline PET/CT scan revealed a right-sided paratracheal nodule with peripheral radiopharmaceutical uptake (figure 3).