A 32-year-old man with a clinical and biochemical profile suggestive of primary hyperparathyroidism presented with a soft tissue mass on the left side of the neck. Multiphasic planar and SPECT Tc-99m sestamibi (MIBI) scintigraphy showed focally increased tracer concentration in the mass. Subsequent histopathology and immunostaining identified the mass as a parathyroid hormone-secreting cervical paraganglioma, indicating that this tumor should be considered in the differential interpretation of MIBI concentration in the neck.