Case Author(s): Samuel Wang, M.D. and Farrokh Dehdashti, M.D. , 5/18/97 . Rating: #D2, #Q3

Diagnosis: Pseudomembranous colitis.

Brief history:

43 year old man on hemodialysis with persistent fevers and leukocytosis.

Images:

Delayed 24 hour anterior and posterior images.

View main image(iw) in a separate image viewer

View second image(iw). Delayed 24 hour spot images.

View third image(ct). CT of the abdomen and pelvis.

Full history/Diagnosis is available below

Diagnosis: Pseudomembranous colitis.

Full history:

43 year old man with end- stage renal disease (on hemodialysis) with persistent fevers and leukocytosis. His Tesio catheter had recently been removed and he was being treated with antibiotics.

Radiopharmaceutical:

0.5 mCi In-111 labeled autologous leukocytes i.v.

Findings:

The delayed 24 hour images demonstrate increased leukocyte accumulation in the left abdomen and pelvis in the distribution of the descending colon and sigmoid. The spleen is absent which by history was removed 20 years ago.

Discussion:

Due to the patient's unstable condition at the time, no early images could be obtained. Ideally, when active inflammatory bowel disease is suspected, early imaging at 4 hours is required for accurate localization of the site of inflammation. If early images are not obtained, the labeled leukocytes may be sloughed into the bowel lumen and be moved distally.

Followup:

Subsequent CT demonstrated diffuse colonic bowel wall thickening also suggestive of pseudomembranous colitis. Stool cultures demonstrated clostridium difficile, and the patient responded well to appropriate antibiotics.

Differential Diagnosis List

Infectious enteritis, ischemic enteritis, GI bleeding, swallowed labelled white blood cells from an upper or lower respiratory tract infection.

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: iw005

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