Early and 3-hour delayed Tc-99m MIBI SPECT scans were performed on a 57-year-old male patient with a high clinical suspicion of hyperparathyroidism. The early images demonstrated projection of tracer activity posterior to the inferior pole of the right thyroid lobe. The 3-hour delayed images revealed complete tracer washout from this region as well as the rest of the thyroid gland. Imaging with ultrasound, followed by surgical excision and pathology, confirmed a parathyroid adenoma. The authors present this case of posterior bulge appearance on the early Tc-99m MIBI presenting with normal clearance on the delayed images.