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Ischemic colitis: Tc-99m HMPAO leukocyte scintigraphy and correlative imaging
1Department of Radiology, University of Illinois-Chicago Medical Center, 60612, USA.
Insights
Technetium Tc-99m HMPAO leukocyte scans may help diagnose ischemic colitis, a complication after aortic graft surgery. This imaging technique offers a noninvasive method for detecting colon injury, potentially improving patient outcomes.
Area of Science:
- Nuclear Medicine
- Gastroenterology
- Vascular Surgery
Background:
- Aorto-bifemoral graft surgery can lead to complications like graft infection or ischemic injury.
- Ischemic colitis presents with nonspecific symptoms, often delaying diagnosis and increasing mortality risk.
Observation:
- A patient experiencing progressive illness post-aorto-bifemoral graft surgery underwent Tc-99m HMPAO leukocyte scintigraphy due to suspected graft infection.
- Scintigraphy revealed significant radiotracer uptake in the sigmoid colon, prompting further investigation.
Findings:
- Follow-up CT and X-ray studies identified an abnormal sigmoid loop.
- Surgical resection confirmed ischemic changes in the sigmoid colon, diagnosing ischemic colitis.
Implications:
- Tc-99m HMPAO leukocyte scintigraphy may serve as a valuable noninvasive tool for diagnosing ischemic colitis.
- Early detection of post-surgical ischemic colon injury can be improved, especially in patients with aortic grafts.
- This diagnostic approach could potentially reduce mortality associated with delayed ischemic colitis diagnosis.
Abstract:
A 62-year-old woman became progressively ill after aorto-bifemoral graft surgery. A Tc-99m hexamethylpropyleneamine oxime (HMPAO) leukocyte scan was performed because of fever and suspected graft infection. The anterior abdominal and pelvic views demonstrated marked uptake within the sigmoid colon. Follow-up studies, including CT scan and contrast intestinal x-rays, confirmed the presence of an abnormal sigmoid loop. Subsequent surgical resection and pathological examination of the sigmoid colon revealed ischemic changes. To our knowledge, detection of ischemic colitis using Tc-99m HMPAO labeled leukocytes has not been reported. Clinical and routine radiological findings of ischemic colitis are typically nonspecific and may result in delayed diagnosis that can lead to high mortality. Tc-99m HMPAO leukocyte scintigraphy may be helpful in the noninvasive diagnosis of ischemic injury to the colon, especially after aortic graft surgery.
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