technetium-tc-99m-sulfur-colloid and Chemical-and-Drug-Induced-Liver-Injury

Drug induced hepatitis is a rare complication of thiourea antithyroid drugs. In some patients, the hepatotoxicity may be severe and lead to submassive hepatic necrosis (SHN). Submassive hepatic necrosis is a potentially fatal complication which is usually recognized on the liver biopsy and histological examination or autopsy. In the case presented here, SHN was identified on Tc-99m SC liver images. Sharply defined intrahepatic photopenic abnormalities without significant colloid shift were noted. SPECT images were most remarkable and exhibited extensive liver necrosis. Resolution of hepatic abnormalities correlated with clinical and biochemical resolution of SHN. In patients with propylthiouracil hepatotoxicity, serial liver SPECT images with Tc-99m SC appear helpful for the diagnosis and follow up of SHN and, in an appropriate clinical context, may obviate the need for liver biopsy.

Topics: Adult; Chemical and Drug Induced Liver Injury; Female; Graves Disease; Humans; Liver; Necrosis; Propylthiouracil; Technetium Tc 99m Sulfur Colloid; Tomography, Emission-Computed, Single-Photon

In this case of prolonged fever and abnormal liver functions, dual tracer scintigraphy with In-111 WBCs and Tc-99m SC led to a biopsy-proven diagnosis of severe acute toxic hepatitis (hepatocellular necrosis). Correlation of the Tc-99m SC scan findings with those previously reported for "pseudotumors" of the liver is discussed. A "pseudonormal" scan pattern is described for the In-111 WBC scintigraphy. Discordance between In-111 WBC and Tc-99m SC scintigraphy in this clinical setting should raise the possibility of hepatic necrosis as a diagnostic alternative to hepatic abscess.

Topics: Adult; Chemical and Drug Induced Liver Injury; Female; Humans; Indium Radioisotopes; Leukocytes; Liver; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

A discordant hepatic uptake between Tc-99m sulfur colloid and Ga-67 citrate has occurred in an adult patient with hepatotoxicity due to hypervitaminosis A. The authors believe this is a scintigraphic phenomenon related to the characteristics of the radiopharmaceuticals used and does not necessarily represent a true dissociation of various cellular functions of the liver.

Topics: Chemical and Drug Induced Liver Injury; Female; Gallium Radioisotopes; Humans; Hypervitaminosis A; Kupffer Cells; Liver; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid