Cold defect on indium leukocyte scanning of a hepatic abscess

Abdominal and, specifically, hepatic abscesses have always been difficult to diagnose clinically. The In-111 leukocyte scan has proven to be a valuable modality assisting in the diagnosis of an abscess. The authors present the case of a 64-year-old man who presented with vague clinical symptoms and inconclusive laboratory data for a hepatic abscess. Both the ultrasound and CT scan were nondiagnostic; however, a distinct cold defect within the liver on an In-111 leukocyte scan resulted in a liver biopsy, confirming the presence of an abscess. The potential causes of cold defects on In-111 WBC scanning and the limitations of this modality are discussed.