Ming-Fong Tsai

Diagnosis and treatment of pyogenic psoas abscess in diabetic patients: usefulness of computed tomography and gallium-67 scanning

OBJECTIVES To examine retrospectively the clinical presentations, microbiologic characteristics, and treatment outcomes of psoas abscess in patients with diabetes mellitus (DM) and to assess the usefulness of computed tomography and gallium-67 scanning in its early diagnosis. METHODS During a 9-year period, psoas abscesses in patients with DM were collected at a medical center. The clinical history and associated etiologic factors, microbiologic results, clinical outcomes, and hospitalization days were recorded. The use of imaging in the diagnosis of psoas abscess and other concomitant infectious lesions was also studied. RESULTS Fifteen patients with DM and psoas abscess (13 women and 2 men; mean age 58.7 +/- 9.0 years) were found. The most frequent symptom was fever (12 of 15). Of the six different microorganisms that grew in the blood and/or abscess cultures, Staphylococcus aureus was the most frequent (7 of 15). The most commonly associated pathologic finding was vertebral osteomyelitis (5 of 15). Computed tomography and/or magnetic resonance imaging confirmed the diagnosis of psoas abscesses in all 15 patients. The gallium-67 scan especially aided in the diagnosis of the patients who had initially been diagnosed as having fever of unknown origin (4 of 5) and in the diagnosis of concomitant lesions (9 of 12). Debridement or surgical drainage of the abscess was done in 12 patients. All the patients received adequate antibiotic treatment. However, the mortality rate was 20%. The average hospitalization stay was 42.7 +/- 20.7 days. CONCLUSIONS Psoas abscess in patients with DM is a disease with both diagnostic and therapeutic challenges. We found the infecting microorganisms to be variable and the mortality rate high.

Gallium-67 Scanning in Endogenous Klebsiella endophthalmitis with Unknown Primary Focus

A whole-body gallium-67 (Ga-67) scan of a 61-y-old male with diabetes mellitus who suffered from endogenous Klebsiella endophthalmitis is reported. The scan revealed right orbital and lower abdominal lesions. Urinary analysis revealed pyuria. The causes of endogenous Klebsiella endophthalmitis and the usefulness of Ga-67 are discussed.A whole-body gallium-67 (Ga-67) scan of a 61-y-old male with diabetes mellitus who suffered from endogenous Klebsiella endophthalmitis is reported. The scan revealed right orbital and lower abdominal lesions. Urinary analysis revealed pyuria. The causes of endogenous Klebsiella endophthalmitis and the usefulness of Ga-67 are discussed.

Repeated gallium-67 scan demonstrating an occult mycotic aneurysm of the aortic arch due to Salmonella.

A 71 y-old female with 40°C fever and a change in consciousness during haemodialysis was referred for a gallium-67 scan, which revealed a horseshoe-like radioactive accumulation in the mediastinal region. Salmonella enteritidis was isolated from blood culture. Magnetic resonance imaging confirmed an aortic arch aneurysm. The patient died without surgery.

99mTc-sulphur-colloid and heat-denatured 99mTc-labelled red cell scans demonstrating a giant intrapelvic spleen in a girl after splenectomy.

Abstract A 17 × 12 × 5-cm giant intrapelvic mass in a 14-year-old girl is reported. This mass developed 6 years after a splenectomy for splenic torsion. The heat-denatured 99 mTc-labelled red cell scan and 99 mTc- sulphur-colloid scan confirmed the specific red cell sequestration function and reticuloendothelial activity in the giant intrapelvic spleen. The size and development of the giant intrapelvic spleen are unusual. The usefulness of functional images to diagnosis the nature of the intrapelvic mass is well demonstrated.

Quantitative cerebral perfusion SPECT in systemic lupus erythematosus with severe central nervous involvement--before and after methylprednisolone pulse therapy.

Severe cerebral involvement may occur in patients with systemic lupus erythematosus. Methylprednisolone pulse therapy is a management choice for those with severe cerebral involvement. However, its effectiveness is uncertain. This article describes Tc‐99m HMPAO cerebral perfusion singlephoton emission computerized tomography to document the restoration of cerebral perfusion after methylprednisolone pulse therapy in a case of systemic lupus erythromatosus with severe cerebral manifestations.

Pyometra as a lower abdominal doughnut sign on a Ga-67 scan.

A 77-year-old woman was referred for Ga-67 scan to evaluate intermittent fever and chills that had lasted more than 20 days. The Ga-67 whole-body scan revealed a doughnut-shaped Ga-67 accumulation in the lower abdominal region. Combined Ga-67 and Tc-99m MDP bone scan confirmed that this activity was in the uterus, because the shape of the urinary bladder on bone scan was different from that of the Ga-67-avid lesion. Pyometra was proved during operation, and pus culture was performed.

Biliary and liver abscesses demonstrated with Tc-99m DISIDA and Ga-67 imaging.

A 76-year-old woman with fever of unknown origin had a cholecystectomy 2 months earlier. Blood and pus cultures from percutaneous transhepatic drainage showed Staphylococcus aureus. Immediately after drainage, both Tc-99m DISIDA and Ga-67 imaging were performed. Tc-99m DISIDA cholescintigraphy showed stasis of radiotracer at the dome of the right hepatic lobe and in the biliary tree. The Ga-67 scan revealed multiple focal areas of increased radiotracer accumulation in both hepatic lobes. Under both drainage and antibiotic treatment, the patient was discharged in stable condition.

Radionuclide inferior venocavagraphy in Budd-Chiari syndrome before and after angioplasty

The authors discuss a series of radionuclide inferior venocavography (RIVC) studies that were performed on a 57-year-old man who had Budd-Chiari syndrome before and after balloon angioplasty. The RIVC showed IVC obstruction with collateral circulations. The day after successful angioplasty, RIVC showed the temporary coexistence of IVC and the collateral circulation. The latter was unexpected. Two weeks later, a repeat RIVC showed a normal IVC without collateral circulation, including azygos and hemiazygos veins. The temporary coexistence of the patent IVC and collateral circulation after angioplasty should be interpreted carefully as only a transient phenomenon.