Case Author(s): Charles Pringle, M.D., Keith Fischer, M.D. , 06/03/96 . Rating: #D3, #Q4
Diagnosis: small bowel infarction in the right lower quadrant
Brief history:
Abdominal bloating
Images:
Anterior static image of the abdomen
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View second image(xr).
Plain radiograph of the abdomen
Full history/Diagnosis is available below
Diagnosis: small bowel infarction in the right lower quadrant
Full history:
84-year old man with abdominal
pain. Now in intensive care unit with
new onset abdominal bloating.
Radiopharmaceutical:
12 mCi Tc-99m
HMPAO labeled white blood cells i.v.
Findings:
There is markedly increased uptake
in a dilated loop of small bowel in the right upper pelvis,
which roughly correlates with dilated bowel on plain
radiographs. These findings are suggestive of an
infarcted/ischemic bowel loop in this region.
Discussion:
White blood cells can concentrate in the bowel for multiple reasons. In
this patient bowel ischemia was thought most likely from his clinical course.
Other diagnostic considerations include inflamatory bowel disease or
bleeding into the bowel. White blood cells can be swallowed as well and a
pneumonia can result in white blood cells in the GI tract if they are swallowed.
Followup:
This patient was treated
conservatively (as ischemic bowel) and did not
subsequently have further evidence of bowel
infarction.
Differential Diagnosis List
1) bowel
infarction; 2) ischemic bowel; 3) inflammatory bowel
disease; 4) bleeding; 5) swallowed cells
ACR Codes and Keywords:
References and General Discussion of Indium -111 WBC Scintigraphy (Anatomic field:Gasterointestinal System, Category:Inflammation,Infection)
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Case number: iw004
Copyright by Wash U MO
