technetium-tc-99m-sulfur-colloid and Candidiasis

A patient with fungal splenic abscesses is presented in whom multiple noninvasive diagnostic imaging modalities were available for correlation. Of the five imaging modalities, three (Gallium-67, ultrasound and computed tomography) were diagnostically useful, while two (liver-spleen scan and In-111 white blood cell scan) were not as useful. This case also stresses the use of repeated studies correlating with clinical impressions to obtain an accurate diagnosis in a potentially life-threatening condition such as splenic abscess.

Topics: Abscess; Adolescent; Candidiasis; Gallium Radioisotopes; Humans; Immune Tolerance; Indium; Leukemia, Monocytic, Acute; Liver; Male; Radioisotopes; Radionuclide Imaging; Spleen; Splenic Diseases; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray Computed; Ultrasonography

Four children with acute leukemia and surgically documented candidiasis of the liver and/or spleen were examined with a combination of diagnostic imaging modalities including 99mTc-sulfur colloid and 67Ga-citrate scintigraphy, gray-scale ultrasound, and body computed tomography (CT). Abnormalities were detected in every individual examined. 99mTc-sulfur colloid scintigraphy revealed "cold" areas in the liver or spleen. With 67Ga scintigraphy, these areas were "cold" in some individuals and "hot" in others. Gray-scale ultrasound demonstrated hypoechoic lesions with central areas of increased echogenicity in hepatic involvement, and hypoechoic replacement of the spleen in splenic involvement. CT in one patient revealed low-density areas without contrast enhancement within the hepatic parenchyma and unsuspected renal involvement.

Topics: Adolescent; Candidiasis; Child, Preschool; Female; Gallium Radioisotopes; Humans; Infant; Leukemia; Liver Abscess; Male; Splenic Diseases; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray Computed; Ultrasonography