Splenic infarction as a pitfall on labeled red blood cell imaging

Area of Science:

• Gastroenterology
• Nuclear Medicine
• Radiology

Background:

• Gastrointestinal bleeding scintigraphy (GIBS) is a common diagnostic tool for identifying bleeding sources.
• Interpreting GIBS can be challenging due to anatomical variations and pathologies.
• Splenic abnormalities can potentially mimic or obscure findings on GIBS.

Purpose of the Study:

• To report a case where splenic infarction mimicked active gastrointestinal bleeding on GIBS.
• To illustrate the diagnostic challenges posed by splenic variants and pathologies in GIBS interpretation.
• To emphasize the importance of correlating scintigraphic findings with cross-sectional imaging.

Main Methods:

• A patient with a history of gastrointestinal bleeding underwent GIBS using Technetium-99m labeled red blood cells.
• Abdominal computed tomography (CT) was performed to evaluate an area of suspected malignancy.
• Scintigraphic findings were analyzed in conjunction with CT results.

Main Results:

• GIBS showed an area of radiotracer accumulation at the splenic flexure, suggestive of active bleeding.
• CT revealed a splenic infarction, appearing as a "cold" region on the scintigraphic image.
• The splenic infarction altered the pattern of splenic uptake on GIBS, potentially mimicking bleeding.

Conclusions:

• Splenic pathologies, such as infarction, can significantly complicate the interpretation of GIBS.
• Accurate diagnosis requires careful correlation of GIBS findings with cross-sectional imaging like CT.
• Awareness of splenic variants and pathologies is crucial for reliable GIBS interpretation in patients with gastrointestinal bleeding.