SPECT/CT of axillofemoral graft infection

A 73-year-old woman was admitted to the hospital via the emergency room with increasing pain and tenderness in the right axilla and high fevers. She had a long history of peripheral vascular disease with multiple graft failures and recent insertion of a right axillofemoral graft. A computed tomography study of the chest obtained at admission confirmed graft patency and a small fluid collection around the graft at the level below the right axilla. It also confirmed a saccular aneurysm of the aortic arch. A SPECT/CT study of the chest at 3 hours after reinjection of autologous leukocytes labeled with Tc-99m showed intense labeled leukocyte uptake around the vascular graft in the lateral chest wall. Culture of the infected tissue around the excised graft grew Staphylococcus aureus sensitive to all tested antibiotics. Vascular graft infections are rare, with few reported cases of axillofemoral graft infections utilizing Ga-67. Labeled leukocytes have been used successfully in the setting together with CT scanning. This is a rare case of labeled leukocyte uptake in an infected axillofemoral graft by SPECT/CT.