Italo Zanzi

Hepatobiliary scintigraphy after biliary tract surgery

Hepatobiliary scintigraphy provides a rapid, noninvasive, accurate means of assessing patients after biliary tract surgery. This is especially important, given the high incidence of biliary and enteric diseases. In this review article, the role of radionuclide imaging in postcholecystectomy and postgastroenteric surgery patients will be examined, as well as following invasive procedures and trauma.

Reversible functional asplenia in systemic lupus erythematosus.

A 44-year-old woman with a history of systemic lupus erythematosus on no steroid or immunosuppressive medication presented in septic shock complicated by renal failure and disseminated intravascular coagulation. The patient was treated with antibiotics. Liver-spleen scintigraphy with Tc-99m albumin colloid initially failed to reveal tracer accumulation in the spleen. Follow-up study after one year revealed normal tracer uptake in the spleen. The transient blockade of reticuloendothelial system by immune complexes is the most likely mechanism. Other possible mechanisms include disturbed vascular supply due to thrombosis secondary to the disseminated intravascular coagulation or vasculitis.

Splenic Hypofunction in the Nephrotic Syndrome of Childhood

The reticuloendothelial system, including the spleen, subserves important immunologic functions. Loss of splenic function results in an increased incidence of severe bacterial infections and is accompanied by thrombocytosis. Several nephrotic children were noted to have remarkably high platelet counts and predisposition to bacterial infection with encapsulated organisms. We, therefore, investigated the splenic function of nine children with primary nephrotic syndrome and measured the phagocytic function of the spleen by sequestration of Technetium-99-labelled heat-treated autologous RBC, administered intravenously. Four children had decreased splenic function. Repeat studies performed in two of these children after remission of the nephrotic syndrome gave normal results. There were six episodes of bacterial infection (3 peritonitis, 1 septic arthritis, 1 cellulitis, and 1 Escherichia coli urinary tract infection) among the four patients with decreased splenic function. There were no episodes of bacterial infection among the five nephrotic children with normal splenic function. Nephrotic patients with decreased splenic function had significantly increased platelet counts (921,000 +/- 196,000; mean +/- SEM) compared to those with normal function (435,000 +/- 46,000; P less than 0.001). Our findings suggest the possibility that some nephrotic children may have decreased splenic function in association with increased susceptibility to bacterial infections.

Scintigraphic Cerebral Spinal Fluid Leak Study in a Child With Recurrent Meningitis After Resection of a Frontal Meningocele

An In-111 DTP A cerebrospinal fluid (CSF) teak study was performed on a 3-year-old boy admitted with recurrent meningitis. He was born with a congenital encephalocele that was surgically resected at 7 days-of-age. A residual skull floor defect with a recurrent tumor of the nasal radix was clinically suspected. Computed tomography and MRI scans could not confirm or rule out the presence of a CSF leak. The scintigraphic study clearly demonstrated a teak into the left naris. A large leptomenin-geal cyst extending down into the left nares was resected and a defect in the left frontal calvarlum, identified as the source of the CSF leak, was repaired at surgery.

Scintigraphic and magnetic resonance studies in a patient with Gaucher's disease.

ln-111 chloride imaging was used in the evaluation of a patient with Type I Gauchers disease before splenectomy for pancytopenia. This case is the first report of its use in this clinical setting. The image demonstrated the presence of adequate marrow reserve, thereby suggesting that the pancytopenia was due to hypersplenism rather than marrow replacement. Normalization of blood counts after splenectomy confirmed this interpretation. Eight months later, the patient had acute pain in the left knee. Bone imaging suggested a left lateral tibial plateau fracture that was not seen on plain radiographs or magnetic resonance imaging, but was confirmed by x-ray tomography. The significance and implications of these findings are discussed.

Pseudogastroparesis as a presentation of adenocarcinoma of the proximal jejunum

Establishing the presence of adenocarcinoma of the small bowel is exceedingly difficult. Survival is contingent on prompt diagnosis. We describe a patient with an atypical presentation of jejunal adenocarcinoma visualized via small bowel enteroclysis. She was referred with “gastroparesis,” based on both a radionucleotide scan that revealed markedly delayed gastric emptying and a “normal” small bowel series.A markedly abnormal scintigraphic study and a negative small bowel series does not exclude disease of the small intestine and should provide the impetus to further pursue the possibility of an obstructing lesion. The enteroclysis is a relatively safe and effective study in the preoperative diagnosis of small bowel tumors.

Gallbladder perforation and hepatobiliary scintigraphy

The authors present unusual cholescintigraphic imaging in a patient with acute cholecystitis complicated by perforation of the gallbladder. Tc-99m mebrofenin cholescintigraphy revealed obstruction of the cystic duct and alarge photopenic area in the right hepatic lobe. This study correlated with computed tomography scan findings of abundant pericholecystic fluid. The gallbladder perforation and presence of gallstones were confirmed intraoperatively with unremarkable recovery.