Radionuclide image patterns of hepatic metastasis and pyogenic abscess: difficulties in differential diagnosis

A case of hepatic metastasis with a clinical differential diagnosis of amebic and bacterial abscess is presented. Hepatic scanning with 67Ga-citrate did not diagnostically differentiate the lesion. Hepatic arteriography combined with a therapeutic trial of metronidazole proved useful in defining the lesion. An understanding of the pathophysiologic process involved in 67Ga scanning of hepatic lesions suggests a non-invasive method of discriminating among these clinical diagnostic possibilities.