Pyogenic liver abscess presenting as a "warm" lesion in Ga-67 scintigram. A potential pitfall in interpretation

In the Ga-67 scintigram, most pyogenic liver abscesses appear to be areas of high radiotracer concentration; rarely photon-deficient lesions may also occur. We present a 58-year-old man with sepsis and hepatic abscess, demonstrated by a Tc-99m BIDA study and a computerized tomogram of the body, showing homogenous radiogallium uptake throughout the liver in the Ga-67 images. To avoid missing such a "warm" lesion, it is emphasized that abdominal Ga-67 scintigrams for localization of a focal inflammatory lesion should be done along with Tc-99m sulfur colloid or Tc-99m BIDA scintigraphy.