Clinical importance of enteric communication with abdominal abscesses.

Comparison of 99m technetium hexamethylpropylene-amine oxime labelled leucocyte with 111-indium tropolonate labelled granulocyte scanning and ultrasound in the diagnosis of intra-abdominal abscess.

“…"'-In may be advantageous in chronic abscesses with a slow white cell turnover since it results in a higher abscess to background ratio than 99m-Tc-HMPAO,l 8 19 and it has also been shown to be capable of demonstrating communication of abscesses with the bowel lumen. 26 The present study only found one such case, however, and as the abscess was demonstrated using both isotopes the treatment was unaltered. CT Although CT was not studied, it has an important complementary role in abdominal sepsis.625 It has the advantage of providing more precise anatomical information and is particularly useful for the investigation of pancreatic sepsis.…”

“…This was also the experience of Lantto et al 24 who showed 88% sensitivity using ultrasound in these patients compared with 90% using white cell scanning. This has also been shown in older studies using "'-In tropolonate,25 26 and an algorithm has been suggested whereby the patient who is not critically ill and has no localising signs should first be examined by white cell scanning because ultrasound is less sensitive in this clinical setting. Since ultrasound is more easily accessed this is often performed first, but a negative scan does not exclude an abscess.…”

“…These findings are in keeping with some other studies,'3 although the reported results are very variable,6 25 and reflect the fact that this technique is highly dependent on the operator. Previous retrospective studies have shown low sensitivity using ultrasound particularly in the absence of localising signs.6 26 Thus, if clinical suspicion remains high after an initial negative ultrasound scan, patients should have further investigations such as white cell scanning or CT.…”

Indium-111 leucocyte scanning--underused?

“…Abscesses with enteric drainage have fewer localising signs and an appreciably lower detection rate by ultrasound scanning. 9 Labelled leucocyte scanning is also valuable for identifying acute osteomyelitis unless the infection is in the spine-the reason for the lower sensitivity at this site is unknown." 12 The test is less sensitive for chronic bone infection (probably because of its characteristically poor granulocyte infiltration) and is less sensitive but more specific than gallium-67 citrate scanning for identifying infection around prosthetic hips.…”