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Cold defect on indium leukocyte scanning of a hepatic abscess
1College of Medicine, Medical University of South Carolina, Charleston, USA.
Insights
Diagnosing hepatic abscesses can be challenging. Indium-111 leukocyte scans offer a valuable tool, identifying a liver defect that led to abscess confirmation in a difficult case.
Area of Science:
- Nuclear Medicine
- Diagnostic Imaging
- Hepatology
Background:
- Hepatic abscesses present diagnostic challenges due to vague symptoms and inconclusive lab results.
- Conventional imaging like ultrasound and CT scans can be non-diagnostic for liver abscesses.
- Indium-111 leukocyte scintigraphy is an established imaging modality for abscess detection.
Observation:
- A 64-year-old male presented with non-specific symptoms suggestive of a hepatic abscess.
- Initial ultrasound and CT scans failed to provide a definitive diagnosis.
- An Indium-111 leukocyte scan revealed a distinct "cold defect" in the liver.
Findings:
- The "cold defect" observed on the Indium-111 leukocyte scan indicated an area of decreased radiotracer uptake, consistent with an abscess.
- Subsequent liver biopsy confirmed the presence of a hepatic abscess.
- The study discusses potential reasons for cold defects on Indium-111 WBC scans.
Implications:
- Indium-111 leukocyte scanning can be crucial in diagnosing challenging hepatic abscess cases when other methods fail.
- This modality aids in guiding targeted interventions, such as liver biopsy.
- Understanding the limitations and potential artifacts of Indium-111 leukocyte scanning is essential for accurate interpretation.
Abstract:
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.
