technetium-tc-99m-sulfur-colloid and Purpura--Thrombocytopenic--Idiopathic

The simultaneous occurrence of idiopathic thrombocytopenic purpura (ITP) and Hodgkin's disease in the same patient is uncommon. There have been only a limited number of reported cases of newly diagnosed ITP following Hodgkin's disease. Even more uncommon is the development of ITP after splenectomy for Hodgkin's disease. Of the reported cases of ITP following splenectomy for Hodgkin's disease, all have been successfully treated with medical therapy. We report an unusual case of an accessory spleen causing ITP in a patient who had undergone a splenectomy for Hodgkin's disease 10 years earlier. The patient underwent hand-held gamma-probe-assisted laparoscopic accessory splenectomy.

Topics: Adult; Diagnosis, Differential; Female; Humans; Laparoscopy; Liver; Purpura, Thrombocytopenic, Idiopathic; Radionuclide Imaging; Spleen; Splenectomy; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray Computed

Laparoscopic excision of retained splenic tissue has been described as a treatment of recurrent hematologic disease after formal splenectomy. It is associated with a shorter hospital stay, more rapid recovery, and lower or equivalent morbidity compared with open surgery. However, intraoperative identification of residual splenic tissue remains difficult, particularly when preoperative computed tomography or magnetic resonance imaging results are unremarkable. It has been suggested that the laparoscopic approach has a lower success rate due to the loss of tactile feedback. We report a case of successful laparoscopic excision of retained splenic tissue using technetium sulfur colloid injection and intraoperative gamma probe localization in a patient with recurrent idiopathic thrombocytopenic purpura, 12 years after open splenectomy. This represents the first report of this intraoperative adjunctive measure for the laparoscopic identification and excision of functional accessory splenic tissue.

Topics: Female; Humans; Intraoperative Care; Laparoscopy; Middle Aged; Purpura, Thrombocytopenic, Idiopathic; Radionuclide Imaging; Radiopharmaceuticals; Recurrence; Spleen; Splenectomy; Technetium Tc 99m Sulfur Colloid

Topics: Abdominal Injuries; Adolescent; Adult; beta-Thalassemia; Diagnosis, Differential; Female; Humans; Magnetic Resonance Imaging; Purpura, Thrombocytopenic, Idiopathic; Splenectomy; Splenosis; Technetium Tc 99m Sulfur Colloid; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

This case report presents a highly unusual finding of ectopic splenic tissue in both the thoracic and abdominal cavities in a patient with recurrent idiopathic thrombocytopenic purpura (ITP).

Topics: Abdomen; Choristoma; Humans; Male; Middle Aged; Purpura, Thrombocytopenic, Idiopathic; Radionuclide Imaging; Radiopharmaceuticals; Recurrence; Spleen; Technetium Tc 99m Sulfur Colloid; Thoracic Diseases

A radiocolloid study was carried out, after splenectomy, in a 75-year-old man who had idiopathic thrombocytopenic purpura. The patient, who did not have an increase in platelet counts after spleen removal or after platelet infusions, showed radiocolloid accumulation in the lungs and in the bone marrow. This suggested some "activation" of reticuloendothelial cells, perhaps by circulating immune complexes. The left femur (site of an episode of poliomyelitis many years previously) had less radiocolloid uptake than the right.

Topics: Aged; Antigen-Antibody Complex; Bone Marrow; Femur; Humans; Liver; Lung; Male; Mononuclear Phagocyte System; Platelet Count; Platelet Transfusion; Postpoliomyelitis Syndrome; Purpura, Thrombocytopenic, Idiopathic; Radionuclide Imaging; Radiopharmaceuticals; Splenectomy; Technetium Tc 99m Sulfur Colloid

The technetium-sulfur colloid liver-spleen examination is widely used to evaluate patients with idiopathic thrombocytopenic purpura for residual splenic tissue following splenectomy. Technetium-labeled heat-damaged red blood cell imaging is another sensitive test for residual splenic tissue. We recently encountered a patient with idiopathic thrombocytopenic purpura who was initially evaluated with a technetium sulfur colloid scan which was negative. A denatured red blood cell scan was subsequently performed which revealed intense focal activity in the region of the splenic bed. Surgery confirmed this to be splenic tissue. Our results emphasize the utility of the denatured red blood cell examination in the setting of strong clinical suspicion for residual splenic tissue following a negative sulfur colloid study.

Topics: Adult; Erythrocytes; Female; Humans; Purpura, Thrombocytopenic, Idiopathic; Radionuclide Imaging; Spleen; Splenectomy; Technetium; Technetium Tc 99m Sulfur Colloid