John J. Sziklas

Causes and temporal sequence of onset of functional asplenia in adults.

To determine the causes and time course of onset of functional asplenia in adults, a four-part investigation was conducted. This consisted of a review of the worlds literature, a survey of colleagues, a detailed study of 4,476 consecutive liver-spleen scans in three hospitals, and continued monitoring of 3,500 scans in five hospitals. Based on the findings, a classification was proposed of the causes of functional asplenia. The two major etiologies were circulatory disturbances and effects directly on splenic reticuloendothelial cells. The time course varied from the essentially instantaneous onset of functional asplenia in patients with acute splenic artery obstruction, to a prolonged and gradual onset in those with chronic damage to splenic reticuloendothelial cells. Functional asplenia was found in 0.14% of the adults who had liver-spleen scans for other indications.

Functional Asplenia in the Absence of Circulating Howell-Jolly Bodies

The term functional asplenia has been used to refer to anatomic presence of the spleen without the ability to accumulate intravenously administered radiocolloid. Functional asplenia had previously been invariably associated with the presence of Howell-Jolly bodies in circulating erythrocytes. The first documented instance of functional asplenia, without the presence of these intraerythrocytic inclusions, is described. The patient suffered acute cellac artery thrombosis. The sudden onset of splenic dysfunction, and accompanying infection, probably accounted for the lack of Howell-Jolly bodies.

Diagnosing osteomyelitis in Gaucher's disease. Observations on two cases.

Bone scans in two patients with Gauchers disease were reported as consistent with Gauchers-associated osseous crises. A bone-radiogallium subtraction study was also initially negative in each individual (although it later became positive in one). At surgery both patients were seen to have osteomyelitis. These two cases point out the difficulty in attempting to diagnose osteomyelitis in the presence of Gauchers bone disease. A possible role for MRI in such instances was mentioned. Also noted was clinical reluctance to accept a diagnosis of osteomyelitis (positive bone-radiogallium subtraction study) in an afebrile Gauchers patient.

Liver Imaging During Reticuloendothelial Failure

Two cases are described of men with hepatic cirrhosis. The liver could not be visualized by means of intravenously administered99M Tc-sulfur colloid. There was thus hepatic “reticuloendothelial failure.” Despite this, in one case the liver could be imaged following intravenous administration of 67 Ga-citrate. In the second case, the liver retained some ability to accumulate 131I-rose bengal. These cases point out the disassociation of hepatic functions, and the ability to call upon one class of radiopharmaceuticals when another is not accumulated.

Pseudo-Budd-Chiari syndrome.

A patient with clinical, laboratory, radiographic and scintigraphic findings resembling the Budd-Chiari syndrome is described. However, at autopsy there was no thrombotic occlusion of any of the intrahepatic veins. The right hepatic vein was completely constricted by the hypertrophied left lobe of the liver, and the left hepatic vein was narrowed. We have referred to this clinical entity as the pseudo-Budd-Chiari syndrome. It represents a potentially treatable form of the Budd-Chiari syndrome.

Dual radionuclide subtraction imaging of the spleen

Dual radionuclide subtraction imaging of the spleen using 67Ga citrate and 99mTc is useful in further delineating lesions that are identified on either a routine radiogallium survey or on a conventional sulfur colloid liver-spleen image. Better anatomic localization of left subphrenic abscesses may be obtained. Differentiation of tumors and abscesses from less serious lesions such as cysts, infarcts, and hematomas is possible. We have found this technique to be generally applicable to any organ that can be selectively imaged using a technetium radiopharmaceutical, including the liver, bones, and kidneys. In addition, we are currently evaluating thallium-pertechnetate subtraction imaging in the evaluation of parathyroid adenomata.

Radionuclide study of functional resolution of unilateral renal vein thrombosis.

The diagnosis of unilateral renal vein thrombosis was established in a 50-year-old woman. A functional evaluation, by means of Tc-99m DTPA, was performed almost immediately, and at intervals up to nearly eight months later. Functional return of the involved kidney could be documented by plotting the ratio of affected kidney/total kidney activity. Conservative therapy was accompanied by a return of function of the kidney to 45% of total renal activity.

Photopenic to Avid Radiogallium Transition after Rupture of the Marrow Cavity in Acute Femoral Osteomyelitis

A 4-year-old boy had markedly reduced Ga-67 uptake in a painful left leg when compared with the right. A repeat study 9 days later showed an intense accumulation of nuclide in the lower left femur and surrounding area. Increased intramedullary pressure probably precluded Initial Ga-67 delivery into the site of infection, and subsequent release of this pressure permitted accumulation.

Bile Leak from Choledochal Cyst in a Child

Ultrasound of the abdomen in a 3-year-old girl suggested the presence of a choledochal cyst. A hepatobiliary study was consistent with such a cyst. Delayed images, however, revealed periabdominal activity, suggesting a bile leak. At surgery, the choledochal cyst was confirmed and noted to be the source of bile leakage.

Incidental Finding of Intense Thyroid Radiogallium Activity During Febrile Illness

Two elderly adults presented with fever of undetermined origin. Radiogallium imaging showed intense concentration in the thyroid, without abnormal localization elsewhere. In the first case, a repeat radiogallium study performed three weeks later was within normal limits. The patient had 0% uptake of radioiodide, and no demonstrable iodine within the thyroid. This probably represented thyroiditis. In the second case, an elevated T4(RIA) and borderline elevated T3 resin uptake suggested the “dumping phase” of thyroiditis. The two cases indicate that “benign” diseases of the thyroid can be associated with diffuse radiogallium concentration in the gland.