Clinical History

A 74-year-old patient with history of bladder carcinoma and prostate carcinoma, with removal of the bladder and prostate two weeks ago. Patient with fever of unknown origin.

Technique

After obtaining a sample of the patient's blood, the white blood cells were labeled with 500 microcuries of Indium-111. The labeled white blood cells were then reinjected into the patient and whole body anterior and posterior images were obtained with SPECT imaging of the abdomen.

Findings

No abnormal uptake is identified in the chest. There is normal uptake of the labeled white cells by the liver and spleen. On the posterior image there is focal uptake identified in the region of the left renal fossa, which could be in the left kidney or in the left perinephric space. On the anterior image there is activity seen at the level of the right kidney which is not identified on the posterior image. SPECT images identify this to be anterior to the right renal fossa. There is a focal intense area of uptake identified at the level of the right iliac crest. SPECT images demonstrate this area to be corresponding to the region of anastomosis of the ureter with the patient's ileal conduit. There is also increased uptake identified in the pelvis, with a more intense focal area to the left of midline, and diffuse uptake identified on the right. Normal marrow uptake in both femurs is seen. There is asymmetric uptake identified in the proximal tibia, greater on the left as compared to the right. This is most likely due to asymmetries and marrow activity in the proximal tibias. Osteomyelitis in the left tibia would be considered less likely, however, a three phase bone scan could be useful to correlate if clinically indicated.

Impressions

  1. SEVERAL FOCAL AREAS OF ABNORMAL UPTAKE AS DESCRIBED ABOVE, IN THE LEFT RENAL FOSSA, POTENTIALLY INVOLVING THE LEFT KIDNEY OR LEFT PERINEPHRIC SPACE, ANTERIOR TO THE RIGHT KIDNEY, AND THE RIGHT LOWER QUADRANT IN THE REGION OF THE ANASTOMOSIS OF THE ILEAL CONDUIT AND IN THE PELVIS AS DESCRIBED ABOVE. THESE AREAS OF ACTIVITY INDICATE ACTIVE WHITE CELL ACCUMULATION ABOUT INFLAMMATORY OR INFECTIOUS SITES.


  2. MILD ASYMMETRY OF UPTAKE ABOUT THE TIBIAS. NORMAL MARROW DISTRIBUTION DOES NOT NORMALLY EXTENDED TO THE TIBIAS, SUGGESTING SOME ADDITIONAL RECRUITMENT OF MARROW SPACE AND THE ASYMMETRY IS MOST LIKELY RELATED TO ASYMMETRIC DEGREES OF MARROW IN THE TIBIAS, WITH OSTEOMYELITIS CONSIDERED LESS LIKELY, HOWEVER, BONE SCINTIGRAPHY COULD BE USEFUL FOR CORRELATION IF INDICATED.

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