[Algodystrophy versus postoperative infection: use of labelled white cell scans in differential diagnosis in the...

The differential diagnosis between complex regional pain syndrome (CRPS) and postoperative infection is sometimes difficult. We discuss such a case following surgical release of a trigger finger. Because of lack of an accurate diagnosis, the patient was subjected to more and more costly investigations and was operated one more (and unnecessary) time. As white blood cell scintigraphy ((99m)technetium hexamethylpropyleneamineoxime leukocyte [(99m)Tc HMPAO leu]) proved negative, it allowed us to identify with high specificity, a non infectious cause for the problem, and to stop over-investigation and inflation of the costs of treatment. However, the use of white blood cell scintigraphy should remain exceptional, because of its complexity and expense.