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Complicated Inguinal Hernia Incidentally Detected on a Radiolabelled Autologous White Blood Cell Scan
Ilaria Zamberlan1,2, Alberto Nieri2, Luca Urso1,2
1Department of Translational Medicine, University of Ferrara, Ferrara, Italy.
Abstract:
A 73-year-old male with left hip prosthesis infection performed a 99mTc HMPAO-labelled autologous WBC (WBC) scan to evaluate the response to antibiotic therapy. Since the early planar scan, an area of increased activity was visible extending from the left groin region to the ipsilateral flank. At late planar images, the area progressively focused in the left groin, site of a painful inguinal hernia. The contextual tomographic acquisition showed increased activity partly referable to non-specific intestinal contents and partly localized at the parietal wall of the herniated intestinal loop. Our case suggests that the incidental detection of increased accumulation of WBC in correspondence of the intestinal wall of an inguinal hernia may indicate inflammatory involvement and subsequent further complications.
Insights
Technetium Tc 99m HMPAO-labeled white blood cell (WBC) scans can reveal inflammation in inguinal hernias. Increased WBC activity in the hernia wall may signal inflammatory involvement and potential complications.
Area of Science:
- Nuclear Medicine
- Diagnostic Imaging
- Infectious Disease Imaging
Background:
- Infection following hip prosthesis surgery requires monitoring for treatment efficacy.
- White blood cell (WBC) scintigraphy is utilized for infection detection and therapeutic response assessment.
- Inguinal hernias can present diagnostic challenges, especially when co-existing with other medical conditions.
Purpose of the Study:
- To evaluate the utility of 99mTc HMPAO-labeled autologous WBC scintigraphy in assessing response to antibiotic therapy in a patient with a hip prosthesis infection.
- To investigate the significance of incidental findings of increased WBC activity in the region of an inguinal hernia during infection monitoring.
Main Methods:
- A 73-year-old male with a left hip prosthesis infection underwent 99mTc HMPAO-labeled autologous WBC scintigraphy.
- Planar and tomographic imaging techniques were employed to assess the distribution of radiolabeled WBCs.
- The scan was performed to evaluate the response to antibiotic treatment.
Main Results:
- Early planar scans showed increased activity in the left groin extending to the flank.
- Late planar images revealed focused activity in the left groin, corresponding to a painful inguinal hernia.
- Tomographic acquisition demonstrated increased WBC activity within the herniated intestinal loop, partly attributed to intestinal contents and partly to the parietal wall.
Conclusions:
- Incidental detection of increased WBC accumulation in the intestinal wall of an inguinal hernia may indicate inflammatory involvement.
- This finding suggests potential for further complications related to the hernia.
- WBC scintigraphy may offer insights into inflammatory processes within inguinal hernias, even when used for other indications.
