technetium-tc-99m-sulfur-colloid and Splenic-Rupture

Despite the fact that the spleen has multiple functions, only one has been widely used for evaluation of the organ by imaging techniques (phagocytosis of 99mTc sulfur colloid). The usual splenic uptake of this radiocolloid can by used to determine the size, location, and integrity of the organ. A major use of splenic radiocolloid imaging has been in the study of congenital defects. Thus, eventration of the diaphragm, accessory spleens, splenogonadal fusion, the asplenia and polysplenia syndromes, and the wandering spleen are amenable to study by means of intravenously administered radiocolloid. Interference with the splenic uptake of radiocolloid can be either focal or generalized (as in functional asplenia). Imaging of the spleen has a major role in evaluating suspected trauma of the organ and in following its clinical course. The return of splenic function after splenectomy (splenosis or accessory spleens) can be documented by radionuclide imaging, and likely by hematologic techniques when the volume of tissue is sufficiently large. The detection of intrasplenic lesions is important in tumor staging and as an alerting sign to an ongoing process.

Topics: Abscess; Adult; Child; Child, Preschool; Cysts; Diaphragmatic Eventration; Humans; Hypersplenism; Phagocytosis; Postoperative Complications; Radiation Dosage; Radionuclide Imaging; Spleen; Splenic Diseases; Splenic Neoplasms; Splenic Rupture; Splenomegaly; Technetium Tc 99m Sulfur Colloid

To evaluate the clinical and laboratory characteristics of patients submitted to subtotal splenectomy during the immediate and late postoperative period.. The study was conducted on 34 patients, 25 of whom were submitted to subtotal splenectomy (group I), and 9 to total splenectomy without preservation of splenic tissue (group II), and on 22 patients with intact spleens (group III, control). The immediate and late postoperative complications were investigated. Hematological examinations were performed during the late postoperative period (red cell count, hemoglobin, platelets, total and segmented leukocytes, lymphocytes, and Howell-Jolly bodies). Immunoglobulins (IgA, IgM, and IgG) and total T lymphocytes (TTL), active T lymphocytes (ATL), and B lymphocytes were also determined. Splenic scintigraphy with (99m)Tc colloidal sulfur was performed.. Groups I and III did not presented abnormal blood bodies and their hematological and immunological pattern were normal. None of the groups showed leukocytosis or thrombocytosis. Howell-Jolly bodies were observed only in group II, which also showed reduced IgM levels. Scintigraphy showed filtering splenic tissue in group I.. We conclude that subtotal splenectomy is a good surgical alternative for serious distal spleen lesion or when the main splenic pedicle is injured.

Topics: Adolescent; Adult; Blood Cell Count; Blood Proteins; Child; Child, Preschool; Female; Humans; Immunoglobulins; Male; Middle Aged; Postoperative Period; Radionuclide Imaging; Radiopharmaceuticals; Spleen; Splenectomy; Splenic Rupture; Technetium Tc 99m Sulfur Colloid; Trauma Severity Indices; Treatment Outcome

Intrathoracic splenosis is a rare diagnosis that is usually made following an invasive procedure. Although radiographic and CT findings are nonspecific, these findings combined with a history of splenic injury should suggest the possibility of this diagnosis. We present a patient with intrathoracic splenosis diagnosed on the basis of a technetium Tc 99m heat-damaged RBC scan following false-negative technetium Tc 99m sulfur colloid scan results.

Topics: Diaphragm; Erythrocytes; False Negative Reactions; HIV Seropositivity; Humans; Male; Middle Aged; Pleura; Postoperative Complications; Radionuclide Imaging; Splenic Rupture; Splenosis; Technetium; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray Computed

Topics: Abdomen; Humans; Liver Cirrhosis; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Splenectomy; Splenic Rupture; Splenosis; Technetium Tc 99m Sulfur Colloid

Topics: Abdominal Neoplasms; Choristoma; Diagnosis, Differential; Humans; Male; Middle Aged; Radionuclide Imaging; Spleen; Splenic Rupture; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray Computed

Overwhelming infection after splenectomy remains a problem despite the introduction of vaccine and antimicrobial prophylaxis. To evaluate prospectively various procedures proposed for salvage of the spleen, we measured reticuloendothelial function for two to five years in 51 patients who had initially presented with abdominal trauma and suspected splenic rupture. The mean percentage of pocked erythrocytes and the clearance of antibody-coated autologous erythrocytes in 8 patients who had splenic repair and in 6 who had partial splenectomy were the same as in 11 controls with intraabdominal injury that did not involve the spleen. The mean percentage of pocked erythrocytes remained significantly elevated in 19 patients who had undergone total splenectomy without autotransplantation of splenic tissue. One of seven patients who underwent splenic autotransplantation had a normal level of pocked erythrocytes 18 months after surgery, and a second patient had only a slight elevation at 24 months. The mean (+/- SEM) half-time clearance of labeled erythrocytes was significantly longer in the group that had total splenectomy without autotransplantation (421.1 +/- 74.5 hours) than in the autotransplantation group (91.6 +/- 20.0) or in the controls (5.4 +/- 2.0). We conclude that reticuloendothelial function was better preserved after partial splenectomy and splenic repair than after splenic autotransplantation, but that autotransplantation was superior to total splenectomy and appeared to be safe. Splenic autotransplantation deserves further study in patients who have had splenic trauma when other surgical maneuvers to save the spleen are not possible.

Topics: Adolescent; Adult; Child; Child, Preschool; Chromium Radioisotopes; Erythrocytes; Humans; Infection Control; Methods; Middle Aged; Mononuclear Phagocyte System; Postoperative Complications; Prospective Studies; Spleen; Splenectomy; Splenic Rupture; Technetium Tc 99m Sulfur Colloid; Transplantation, Autologous

To assess the radiosulfur colloid distribution in the liver-spleen scans of trauma patients, 73 trauma patients (age: 4-74 years, mean: 32 years) who had Tc-99m sulfur colloid liver-spleen scans for trauma workup were studied and compared with the liver-spleen scans of 87 control patients (age: 2-64 years, mean: 36 years). Radiocolloid distribution was visually assessed by two physicians independently, and the areas of the greatest density in the liver and spleen on the posterior view that included both organs were compared. The scans were grouped into three grades: Grade I, liver density greater than spleen density; Grade II, both organs showing equal density; and Grade III, splenic density greater than liver density (colloid shift). Forty-three of the trauma patients (59%) were in Grade III, 22 (30%) in Grade I, and 2 (11%) in Grade II. The control group had 12 (14%) patients in Grade III, 54 (62%) in Grade I, and 21 (24%) in Grade II. When the young adults and children of the trauma patients (age: 4-20 years, mean: 14 years) were looked at separately, 17 of 20 (85%) showed colloid shift (Grade III). It is concluded that there is a significantly higher incidence of colloid shift in trauma patients compared to control patients (P less than .01).

Topics: Adolescent; Adult; Child; Child, Preschool; Female; Humans; Liver; Male; Middle Aged; Radionuclide Imaging; Spleen; Splenic Rupture; Technetium Tc 99m Sulfur Colloid; Wounds, Gunshot; Wounds, Nonpenetrating; Wounds, Stab

The first task of radiocolloid spleen imaging, after trauma, is to determine if the organ is functioning. If this cannot be demonstrated, splenic avulsion must be considered. The second task is to document splenic injury (not to suggest splenectomy, but to serve as a baseline for following later healing). Failure to heal may be a risk factor for subsequent splenic rupture. The third task of spleen imaging is to determine if accessory splenic fragments are present and functional. The radiocolloid spleen scan facilitates the successful accomplishment of all of these tasks.

Topics: Adolescent; Adult; Aged; Child, Preschool; Female; Humans; Iatrogenic Disease; Male; Middle Aged; Postoperative Complications; Radionuclide Imaging; Rupture; Spleen; Splenectomy; Splenic Rupture; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray Computed

The diagnosis of delayed rupture of the spleen is demonstrated and discussed by presenting a case in which the patient had significant thoracoabdominal trauma with an initially normal liver/spleen scintigram and benign hospital course. Twenty-three days after the trauma, the patient developed an acute abdominal crisis that brought him to the emergency room where an emergency ultrasound revealed hemoperitoneum and a subcapsular hematoma. At laparotomy, a splenic rupture was found. A splenectomy was not performed. Postoperative liver/spleen scintigram showed a persistent defect which was not present on the initial liver/spleen scintigram.

Topics: Abdominal Injuries; Adult; Humans; Male; Radionuclide Imaging; Spleen; Splenic Rupture; Technetium Tc 99m Sulfur Colloid; Thoracic Injuries; Time Factors

Spontaneous splenic rupture is a rare but serious complication of infectious mononucleosis. Although radionuclide spleen imaging is a well accepted method for diagnosis of traumatic rupture, interpretation can be difficult in the setting of mononucleosis, as tears may be ill-defined and diagnosis hampered by inhomogeneous splenic uptake. Four proven cases of spontaneous rupture are presented, three of which illustrate these diagnostic problems.

Topics: Adult; Colloids; Humans; Infectious Mononucleosis; Male; Radionuclide Imaging; Rupture, Spontaneous; Splenic Rupture; Splenomegaly; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

Topics: Adolescent; Humans; Male; Radionuclide Imaging; Spleen; Splenic Diseases; Splenic Rupture; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid