Case Author(s): Christian T. Schmitt, M.D. and Keith C. Fischer, M.D. , 10/14/02 . Rating: #D3, #Q3

Diagnosis: In-111 WBC uptake at concurrent vaccination sites

Brief history:

39 year old man status post splenectomy with suspected abdominal abscess

Images:

4 hr and 24 hr anterior and posterior images are shown

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View second image(iw). 24 hr spot images are shown

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Full history/Diagnosis is available below

Diagnosis: In-111 WBC uptake at concurrent vaccination sites

Full history:

39 year old man status-post mitral valve replacement for severe mitral regurgitation as a result of infective endocarditis. He developed a splenic abscess and underwent emergent splenectomy for a splenic artery aneurysm. There was clinical concern for persistent abdominal abscess. The patient was referred for In-111 WBC scintigraphy. He was injected for the examination. Four hours later he received a pneumococcal vaccine in one arm and a meningococcal vaccine in the other arm. He was subsequently imaged at about 4 and 24 hours.

Radiopharmaceutical:

500 microCi In-111 labeled autologous leukocytes i.v.

Findings:

There is no splenic uptake compatible with the history of splenectomy. No abnormal uptake in the splenic bed or abdomen is identified to suggest abscess. There is asymetric sacroiliac uptake the cause for which was not discovered. Abnormal uptake is noted within the soft tissues of the upper extremities bilaterally in the region of the recent vaccinations.

Major teaching point(s):

Indium-111 white blood cell uptake can be seen at sites of recent vaccinations.

ACR Codes and Keywords:

References and General Discussion of Indium -111 WBC Scintigraphy (Anatomic field:Skeletal System, Category:Normal, Technique, Congenital Anomaly)

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Case number: iw013

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