technetium-tc-99m-sulfur-colloid and Liver-Abscess

Topics: Breast Neoplasms; Hemangioma; Humans; Liver Abscess; Liver Cirrhosis; Liver Diseases; Liver Neoplasms; Organotechnetium Compounds; Phytic Acid; Radiation Injuries; Radionuclide Imaging; Radiotherapy; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

The localization of intraabdominal abscesses is a difficult imaging problem in nuclear medicine, especially when the location of the abscess is in the area of the liver and spleen. The need for performing Tc-99m sulfur colloid liver-spleen scans before injecting indium-111 leukocytes for improved lesion detection and characterization versus performing In-111 leukocyte scans alone has been questioned in the literature. We present 3 patients with intraabdominal abscesses in the liver-spleen area, in which liver-spleen scans were performed before In-111 leukocyte scans. The findings of all were correlated with computed tomography and interventional procedures.. In all patients, the Tc-99m liver-spleen scan helped for accurate recognition of the location of the abscess, correlated with computed tomography findings, and were helpful for intervention and exclusion of the other sources of infection.. Data from these 3 patients reinforces the need for Tc-99m sulfur colloid liver-spleen scans before performing In-111 WBC scans for better localization and interventional treatment of intraabdominal abscesses.

Topics: Abdominal Abscess; Aged; Female; Humans; Image Enhancement; Indium Radioisotopes; Leukocytes; Liver; Liver Abscess; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Spleen; Splenic Diseases; Subtraction Technique; Technetium Tc 99m Sulfur Colloid

On In-111 WBC images, diffuse homogeneous uptake of the radiopharmaceutical should be present throughout the liver. The authors present a case of a febrile patient with polycystic liver disease in whom the normal diffuse uptake was not seen. Instead, the images demonstrated focal areas of uptake, which suggested infection. Tc-99m SC liver spleen scintigraphy demonstrated the In-111 WBC foci to correspond to areas of residual normal parenchyma. The patient underwent laparotomy and liver transplantation and no abscesses were found. Pathologic examination of the liver revealed multiple uninfected cysts and residual normal parenchyma in the caudate lobe, corresponding to the findings on scintigraphy.

Topics: Cysts; Diagnosis, Differential; Humans; Indium Radioisotopes; Leukocytes; Liver; Liver Abscess; Liver Diseases; Male; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

A 46 year-old white male with fever of unknown origin demonstrated a multiloculated hepatic cyst on abdominal CT. Persistent fever and leukocytosis prompted Tc-99m Sulfur colloid liver-spleen and gallium-67 citrate imaging to identify a possible liver abscess. SPECT imaging provided pertinent clinical information that allowed the diagnosis of abscess to be made.

Topics: Citrates; Gallium Radioisotopes; Humans; Liver Abscess; Male; Middle Aged; Radiography, Abdominal; Technetium Tc 99m Sulfur Colloid; Tomography, Emission-Computed; Tomography, X-Ray Computed

We report on a case of multiple hepatic abscesses in an immunodeficient patient where initial radiologic evaluation by ultrasonography and computed tomography confused early management by failing to demonstrate the abscesses and by suggesting other diagnoses. Indium 111 (In-111) white blood cell (WBC) scanning with Tc-99 liver-spleen scan subtraction accurately demonstrated subcapsular hepatic abscesses in four out of four sequential studies, and later confirmed resolution of the abscesses. We suggest that In-111 WBC scanning may be used as a highly specific method of diagnosing suspected upper abdominal abscesses in children.

Topics: Child; Escherichia coli Infections; Humans; Indium Radioisotopes; Leukocytes; Liver Abscess; Male; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid; Wiskott-Aldrich Syndrome

Most pyogenic liver abscesses appear to be 'not' in a 67Ga-citrate study; rarely, a 'warm' or 'cold' area may also be seen. We present a patient with a pyogenic liver abscess that had both 'cold' and 'hot' areas in the 67Ga-citrate study. This striking finding is probably related to the different stages of evolution of the abscess.

Topics: Drainage; Gallium Radioisotopes; Humans; Inflammation; Liver; Liver Abscess; Male; Middle Aged; Radionuclide Imaging; Streptococcal Infections; Streptococcus sanguis; Technetium Tc 99m Sulfur Colloid

Twenty-five patients with pyogenic liver abscess admitted to the Royal Brisbane Hospital between 1970 and 1982 have been reviewed. The mortality rate was 32%; however, all patients who were diagnosed before death survived. In seven patients there was a history of biliary obstruction or biliary surgery of whom six died. The mean age of the patients who died was significantly higher than those surviving and it is suggested that this resulted from overdiagnosis of malignancy in the elderly, some hesitancy in investigating older patients, and a tendency to attribute multiple space-filling defects to metastatic tumour. If liver biopsy or even exploratory laparotomy have failed to confirm the diagnosis of hepatic abscess the clinician should not discard the possibility. It is concluded that the continuing high mortality from liver abscess is in large part due to lack of clinical awareness and failure in diagnosis rather than to inadequate therapy.

Topics: Age Factors; Aged; Biopsy; Female; Humans; Laparotomy; Liver; Liver Abscess; Male; Middle Aged; Suppuration; Technetium Tc 99m Sulfur Colloid; Ultrasonography

In the Ga-67 scintigram, most pyogenic liver abscesses appear to be areas of high radiotracer concentration; rarely photon-deficient lesions may also occur. We present a 58-year-old man with sepsis and hepatic abscess, demonstrated by a Tc-99m BIDA study and a computerized tomogram of the body, showing homogenous radiogallium uptake throughout the liver in the Ga-67 images. To avoid missing such a "warm" lesion, it is emphasized that abdominal Ga-67 scintigrams for localization of a focal inflammatory lesion should be done along with Tc-99m sulfur colloid or Tc-99m BIDA scintigraphy.

Topics: Gallium Radioisotopes; Humans; Imino Acids; Kidney Failure, Chronic; Liver; Liver Abscess; Male; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

We describe four cases of multiple, cryptogenic, and streptococcal liver abscesses which were cured with antibiotic therapy. Two of the patients were referred for medical management as a last resort after open surgical drainage failed to eradicate the suppurative process. The other two patients were treated from the time of diagnosis with antimicrobial agents alone. Blood cultures or needle aspirates of the abscesses yielded a pure growth of streptococci in all instances. All isolates were susceptible to penicillin G. Cryptogenic streptococcal abscesses may represent a subset of multiple hepatic abscesses particularly amenable to successful medical therapy consisting of a minimum of 6 weeks parenteral antibiotic therapy followed by a period of oral antibiotics until clinical, biochemical, and radiological resolution of the abscesses has occurred.

Topics: Adult; Biopsy, Needle; Chloramphenicol; Drainage; Feces; Female; Hepatomegaly; Humans; Liver; Liver Abscess; Male; Middle Aged; Penicillin G; Radiography; Radionuclide Imaging; Salmonella Infections; Salmonella typhimurium; Streptococcal Infections; Streptococcus; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

Topics: Adult; Ascitic Fluid; Diagnosis, Differential; Humans; Liver; Liver Abscess; Lung; Male; Radiography; Radionuclide Imaging; Subphrenic Abscess; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

Topics: Adult; Aged; Carcinoma, Hepatocellular; Colloids; Cysts; Female; Hemangioma; Humans; Liver Abscess; Liver Cirrhosis; Liver Diseases; Liver Neoplasms; Male; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

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

Topics: Aged; False Positive Reactions; Hepatomegaly; Humans; Liver Abscess; Liver Diseases; Male; Posture; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Ultrasonography

Topics: Adult; Humans; Liver; Liver Abscess; Male; Metronidazole; Peptococcus; Radionuclide Imaging; Sepsis; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Tooth Extraction

Topics: Female; Hepatectomy; Humans; Infant; Liver Abscess; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid