Case Author(s): Tom R. Miller, M.D., Ph.D. , 6 June 1995 . Rating: #D2, #Q4
Diagnosis: Splenic infarction.
Brief history:
History of splenic abscess, now with enterobacter septicemia raising the question of recurrent abscess.
Images:
The upper row shows transaxial slices through the liver and spleen at the Tc-99m sulphur colloid energy; the corresponding In-111 WBC slices are on the lower row.
View main image(iw) in a separate image viewer
Full history/Diagnosis is available below
Diagnosis: Splenic infarction.
Full history:
The 43 year-old main underwent ileal resection and colectomy one year ago with subsequent splenic abscess. He now presents with enterobacter septic shock. The current examination is performed to locate a source of infection.
Findings:
Both the Tc-99m sulphur colloid and In-111 WBC images show a defect in the posterolateral portion of the spleen corresponding to a low-attenuation region on a recent computed tomographic study.
Discussion:
The lack of uptake on the WBC images indicates that the lesion does not represent an abscess. The sulphur colloid images show that the lesion is not splenic tissue containing reticuloendothelial cells. The two sets of images were obtained simultaneously with use of photopeaks set to both the Tc-99m and In-111 energies with separate reconstruction of the two sets of projection data.
Major teaching point(s):
1. A negative In-111 white blood-cell study effectively excludes an abscess.
2. WBC scintigraphy can be performed with either In-111 or Tc-99m labeling.
3. The dual-photopeak technique permits simultaneous acquisition of images employing two radiopharmaceuticals with perfect anatomic registration.
Differential Diagnosis List
1. Splenic infarction or scar.
2. Tumor not containing reticuloendothelial cells.
ACR Codes and Keywords:
References and General Discussion of Indium -111 WBC Scintigraphy (Anatomic field:Vascular and Lymphatic Systems, Category:Inflammation,Infection)
Search for similar cases.
Edit this case
Add comments about this case
Read comments about this case
Return to the Teaching File home page.
Case number: iw001
Copyright by Wash U MO