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Unexpected Detection of Abscessualized Lung Carcinoma on Tc-99m-HMPAO-labeled Leukocytes Scintigraphy Misdiagnosed on Chest Computed Tomography

10.4274/mirt.galenos.2020.54366

• Laura Cosma
• Viviana Frantellizzi
• Mariano Pontico
• Giuseppe De Vincentis

Received Date: 27.10.2019 Accepted Date: 12.03.2020 Mol Imaging Radionucl Ther 2021;30(1):60-62 PMID: 33586412

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Technetium-99m (Tc-99m)-hexamethylpropylene amine oxime (HMPAO)-labeled leukocytes scintigraphy is well established for investigating and diagnosing infections in bone and soft tissue, as well as for the detection of occult infection. A 71-year-old female who was recently diagnosed with bronchopulmonary neuroendocrine tumor of the right lung was referred for an intermittent fever of unknown origin associated with chill at night for the last month. Chest computed tomography (CT) scan showed a thrombotic widespread of the superior vena cava and a solid pathological tissue in the superior segment of the inferior lobe of the right lung with consensual atelectasis. Being a carrier of port-a-cath, an infection of this device was suspected. Therefore, Tc-99m-HMPAO-labeled leukocytes single-photon emission computed tomography (SPECT) was performed, and matching pairs of CT scan and Tc-99m-HMPAO-labeled white blood cell SPECT images were fused. Through this means, it was found that the area of the radiotracer increased uptake corresponded with the soft tissue density mass detected by CT scan localized at the inferior lobe of the right lung. The hybrid SPECT/CT fused imaging was crucial for diagnosis of the presence of a lung abscess localized in correspondence with the known lung cancer region.

Keywords: Tc-99m-HMPAO-labeled leukocytes, hybrid imaging, SPECT/CT, FUO, abscess, abscessualized cancer

Ethics

Informed Consent: Informed consent was obtained by patient.

Peer-review: Externally peer-reviewed.

Authorship Contributions

Surgical and Medical Practices: L.C., M.P., Concept: G.D.V., V.F., Design: G.D.V., V.F., M.P., Data Collection or Processing: L.C., M.P., Analysis or Interpretation: G.D.V., V.F., Literature Search: L.C., M.P., Writing: L.C., M.P.

Conflict of Interest: No conflict of interest was declared by the authors.

Financial Disclosure: The authors declared that this study received no financial support.

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1. Signore A, Jamar F, Israel O, Buscombe J, Martin-Comin J, Lazzeri E. Clinical indications, image acquisition and data interpretation for white blood cells and anti-granulocyte monoclonal antibody scintigraphy: an EANM procedural guideline. Eur J Nucl Med Mol Imaging 2018;45:1816-1831.
2. Liberatore M, Gentile G, Follacchio GA, Frantellizzi V, De Vincentis G, Monteleone F, Anagnostou C, Drudi FM, Calvisi V. 99mTc-labeled White Blood Cell Scan as a Guide to Open Biopsy in the Management of Hip and Knee Prosthesis Infection: Preliminary Results. Curr Radiopharm 2017;1029-1034.
3. Lauri C, Tamminga M, Glaudemans AWJM, Juárez Orozco LE, Erba PA, Jutte PC, Lipsky BA, IJzerman MJ, Signore A, Slart RHJA. Detection of Osteomyelitis in the Diabetic Foot by Imaging Techniques: A Systematic Review and Meta-analysis Comparing MRI, White Blood Cell Scintigraphy, and FDG-PET. Diabetes Care 2017;40:1111-1120.
4. Frantellizzi V, Pontico M, Letizia C, De Vincentis G. Bladder wall paraganglioma located using 123I-mIBG SPECT and CT imaging. Rev Esp Med Nucl Imagen Mol 2018;37:253-254.