Gray scale ultrasonic investigation of focal defects on 99Tc sulphur colloid liver scanning.

Radionuclide liver scanning, though a well established technique for the detection of normal liver tissue replacement, has yet to deliver a satisfactory isotope method for distinguishing the benign or malignant nature of a disclosed nonfunctioning area. The solid or cystic nature of focal areas of replacement can be shown by ultrasonic echography, so the malignancy of the area can be inferred. The complementary use of both techniques is recommended.     

Gastrointestinal bleeding: an accessory spleen causing a false-positive Tc-99m-sulfur colloid study

A Tc-99m-sulfur colloid abdominal scan was performed on a 12-year-old girl to localize the site of gastrointestinal bleeding. The study was normal. When bleeding recurred two weeks later, a repeat study revealed a focal abnormality in the upper abdomen. This was thought to be compatible with a small bleed. However, at surgery an accessory spleen was found, accounting for the abnormal scan.     

Splenogonadal fusion-a rare congenital anomaly demonstrated by 99Tc-sulfur colloid imaging: case report.

A case report illustrating the value of spleen scanning in the diagnosis of a rare anomaly characterized by fusion of the spleen and left testis is described. This malformation results from faulty organogenesis during the fifth to the eighth week of fetal development. Only 65 cases have been reported in the world literature. In most instances, the anomaly is recognized as an incidental finding at autopsy or at surgical exploration of the abdomen. In 20% of cases the anomaly is associated with osseous malformations such as peromelia, ectromelia, micrognathia, and talipes.     

Technetium-99m-sulfur colloid. In vitro studies of various commercial kits.

The quality of five commercial 99mTc-sulfur colloid kits was compared. A number of chemical parameters, which characterize the colloids, was used in order to study the influence of variations in the preparation procedures and storage of the final products. The differences between the kits could mainly be referred to the order of addition of the reagents. The quality was generally unaffected by variations in time-intervals during preparation. However, a certain heating time was necessary for optimal labeling. Variations in quantities of acid and buffer were found to influence the particle size as well as the content of unreacted pertechnetate. No deterioration in quality by storage was observed; on the contrary in some cases the content of free activity decreased.     

Lymphoscintigraphy: a comparison of 99Tc(m) antimony sulphide colloid and 99Tc(m) stannous phytate.

In vitro comparison of 99Tc(m) antimony sulphide colloid and 99Tc(m) stannous phytate as well as in vivo studies in six rabbits and seven patients indicate disparity in the colloidal properties and localization of these two agents. The variability in lymphatic uptake and the relatively poor quality of scintigraphic images following interstitial injection of 99Tc(m) stannous phytate, when compared with 99Tc(m) antimony sulphide colloid, provide evidence of the unsuitability of this agent for lymphoscintigraphy. Maintenance of the diagnostic quality of the lymphoscintigraphic image and adherence to interpretive criteria already established therefore preclude the routine use of 99Tc(m) stannous phytate for interstitial lymphoscintigraphy.     

Tc-99m colloid lung uptake in a rare case of toxoplasmosis with liver involvement

Intensive lung accumulation of colloid (Tc-99m phytate) was demonstrated in a child suffering from acquired toxoplasmosis with a rare manifestation of severe liver damage. The possible mechanism and clinical importance of colloid lung concentration in this case is briefly discussed, including a review of the literature on this subject.     

Case report: amoebic liver abscess complicated by a hepatoduodenal fistula.

Amoebic liver abscess (ALA) is a common extra-intestinal presentation of amoebiasis caused by Entamoeba histolytica. The liver abscess may be complicated by rupture into adjacent structures. Common organs involved include thorax, peritoneum and pericardium. Rupture into the gastrointestinal tract is extremely rare. We report a patient who developed a hepatoduodenal fistula complicating an amoebic liver abscess. Suspicions were raised on finding air in the liver abscess on ultrasound scanning. Diagnosis was confirmed on a water-soluble (Gastrografin) swallow (Fig. 1 a,b). Complications of ALA are associated with a high morbidity and mortality and early diagnosis is important. To our knowledge only one previous case of a hepatoduodenal fistula complicating an ALA with radiological confirmation has been reported.     

Technetium-99m-sulfur colloid and pertechnetate blood pool scans in hepatic veno-occlusive disease: case report.

A liver scan on a patient with biopsy-proven hepatic veno-occlusive disease showed multiple areas of decreased sulfur colloid uptake which were not perfused on the blood pool phase of a pertechnetate bolus study.     

Percutaneous catheter drainage of amoebic liver abscess.

Fifteen patients with amoebic liver abscesses underwent percutaneous catheter drainage under ultrasonographic guidance. Thirteen patients had solitary abscesses (right lobe 12, left lobe 1), two had associated subdiaphragmatic collections, while two patients had multiple abscesses. The indications for the drainage included lack of response to medical therapy: imminent rupture in five cases; ruptured liver abscesses in three; enlarging abscesses after hospitalization in three; persistent symptoms in two; and large left lobe abscesses in two. The volume of the abscesses before drainage was 102-1008 ml (mean 432 ml). Pigtail catheters (8 F) were used in nine of the patients and 12 F sump catheters in six. When multiple abscesses and associated subdiaphragmatic collection were present, each was drained separately. The catheters were removed (mean 7 days, range 3-20 days) when patients became apyrexial, catheter drainage was less than 10 ml in 24 h and cavitogram showed a negligible cavity (mean residual volume 5.5 ml, range 3-15 ml). Complications included minor blood loss through the catheter for 12 h in one patient and reappearance of the abscess in another requiring further drainage. Our experience suggests that catheter drainage of amoebic liver abscesses in selected cases is safe and effective, and results in prompt and early resolution of the abscess cavity with restoration of normal parenchyma.     

A false negative by planar scintigraphy liver hemangioma, diagnosed by technetium-99m-red blood cells and technetium-99m-sulfur colloid single photon emission tomography scan

We present a 42-year-old patient who was examined in the Gastroenterology Department of Gaziantep University for chronic abdominal pain, nausea and vomiting. Ultrasonography showed a 4.7 cm solid hepatic mass on the right lateral side of the right lobe of the liver. The patient was then sent to the Nuclear Medicine Department of Gaziantep University for liver scan. After injecting autologous red blood cells labeled with 740 MBq of technetium-99m ((99m)Tc-RBC), early and delayed anterior planar images of the liver showed no significant findings because of the right kidney shine through the liver. Two days later, after injecting again 740 MBq of (99m)Tc-RBC, we performed a single photon emission tomography (SPET) scan but still this scan was nondiagnostic even in the delayed images of the liver. Three days later, after the iv injection of 185 MBq of technetium-99m-sulphur colloid ((99m)Tc-SC), we observed in the delayed SPET images of the liver, a mismatch defect with decreased focal uptake of (99m)Tc-SC at 60 min while the uptake of (99m)Tc-RBC at the same area was normal or slightly increased. The patient was then operated due to bleeding in the abdominal cavity. A cavernous hemangioma was found, confirmed by histology. The absorbed dose from all three diagnostic scanning procedures was: 4 mSv. In conclusion, the mismatch of the SPET delayed images between the (99m)Tc-RBC and the (99m)Tc-SC scans indicated that this procedure was effective for the diagnosis of liver cavernous hemangioma located in this unusual position.     

Indium-111-labeled leukocyte and technetium-99m-sulfur colloid uptake by a malignant fibrous histiocytoma: phagocytosis by tumor cells?

Indium-111-labeled leukocyte imaging, performed on a patient with a calcified mass in the right thigh, demonstrated labeled leukocyte accumulation in this mass. Technetium-99m-sulfur colloid imaging was performed to differentiate labeled leukocyte uptake in heterotopic bone marrow from uptake in a focus of infection. Leukocyte and sulfur colloid images were virtually identical, and the study was interpreted as without evidence of infection. Excision of the mass revealed an angiomatoid malignant fibrous histiocytoma with metaplastic bone formation. While no marrow elements were present in either the tumor or the metaplastic bone, phagocytosis of leukocytes by tumor cells was identified. Phagocytosis of leukocytes by tumor cells may be another cause of white cell accumulation in uninfected neoplasms.