Abstract
Aim: Presentation of rare finding on labeled leukocytes scintigraphy with the misleading false positive interpretation in the detection of inflammatory focus. Methods: Scintigraphy with 99mTc-HMPAO labeled autologous leukocytes on gamma camera with early abdominal images, late whole-body and targeted SPECT/low dose CT.
Results: 72-year-old female was admitted in the clinic for infectious diseases with fever, headache, and painful neck spine with propagation to right upper extremity. Laboratory inflammatory markers were positive for bacterial infection.
CT of the cervical spine was performed due to suspicion of inflammatory process; but only degenerative changes with spinal canal stenosis were found without clear exclusion of spondylodiscitis. MRI of the spine corresponded with the CT finding.
Patients' symptoms subsided after empirical antibiotic treatment, during two weeks. Original inflammatory focus and its' etiology remained unclear.
Gastroscopy was performed due to episode of melenous stools with the conclusion mild gastritis, the stomach great curvature was situated to the opposite side. Ultrasonography of the abdomen demonstrated hepatomegaly with an enlarged left lobe, extended to the left side, spleen was described as non-enlarged homogeneous (otherwise normal).
Scintigraphy with labeled leukocytes was performed to complete the search for the infectious process. Four pathological accumulations of abdominal activity were detected in the right epi- to mesogastrium dorsolaterally.
There was a diagnostic question between inflammation and possible splenosis. Abdominal situs viscerum inversus was recognized on CT, the main liver parenchyma propagated to the left (right lobe large, left relatively small), the heart was in the usual location.
Fragmented spleen was situated on the right and composed of four parts corresponding with the finding on the scintigraphy. Conclusion: Atypically localized foci with markedly increased accumulation of labeled leukocytes were diagnostically misleading and led to incorrect consideration of inflammatory process, but finally revealed the situs viscerum inversus abdominalis in a 72-year-old patient.