Superior Demonstration of Splenosis by Heat-Denatured Tc-99m Red Blood Cell Scintigraphy Compared With Tc-99m Sulfur Colloid Scintigraphy

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A 41-year-old woman who had undergone splenectomy 24 years previously after a road traffic accident was investigated for deranged liver function tests after an upper respiratory tract infection. Subsequent serology confirmed acute Epstein-Barr virus infection. Abdominal ultrasound demonstrated a solid nodule between the liver and right kidney. Computed tomography (CT) of the abdomen identified 5 further nodules around the stomach and in the lower abdomen. A Tc-99m sulfur colloid study was performed to confirm a suspected diagnosis of splenosis. Uptake could be clearly identified in only 3 of the nodules, so a Tc-99m heat-denatured red blood cell (RBC) study was undertaken. This showed clear uptake in all of the identified nodules as well as uptake in smaller nodules not perceived on CT, thus confirming the diagnosis of splenosis and demonstrating the superior sensitivity of heat-denatured RBC scintigraphy in the identification of heterotopic splenic tissue.

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