Abscess or inflammatory scanning, also known as leukocyte imaging, is a nuclear study performed to assist in the diagnosis of inflammatory lesions indicating an infectious process. Abscess detection by nuclear scanning is performed on clients suspected of having an abscess but with no localized signs of infection. Abnormalities are identified by scanning 24 hours after the IV injection of 111In administered as indium In 111 oxine-labeled leukocytes (WBCs) that are separated from other components of the blood. This is followed by the injection of 99mTc administered as technetium Tc 99m sulfur colloid and the performance of a liver and spleen scan to compare with the indium In 111 oxine-labeled WBC scan. Diagnosis is based on the intensity of uptake outside of normal organs as compared with the liver. CT and ultrasonography are performed to provide a diagnosis in a client with localized signs of an abscess.⁴²

• Absence of uptake of radionuclide outside of normal organs; no inflammation in the abd-omen, lungs, or gastrointestinal tract

• Inability of client to remain still during the procedure
• Gastrointestinal bleeding caused by ulcers, diverticula, or tumors
• Other sites that take up the radionuclide, such as colostomies, hematomas, postoperative wounds, or IV catheters
• Long-term therapies, such as hemodialysis, hyperalimentation, or steroidal or antibiotic therapy, which affect the function of the WBCs

[Show Section Outline]

Indications

• Diagnosing abdominal abscess revealed by focal area of increased uptake that is greater or equal to the liver
• Diagnosing lung infections revealed by focal or diffuse uptake of the radionuclide (although uptake can be caused by CHF, aspiration, atelectasis, or pulmonary emboli)
• Determining whether an infection is causing an elevated temperature of unknown origin
• Diagnosing infectious disorders of the gastrointestinal tract, such as necrotic bowel, inflammatory bowel disease, or pseudomembranous colitis, which are revealed by a greater intensity of uptake
• Diagnosing inflammatory processes in the extremities, such as osteomyelitis

Contraindications

• Pregnancy, unless the benefits of performing the study greatly outweigh the risks to the fetus

[Section Outline]

• Indications
• Contraindications

Nursing Care Before the Procedure

Client teaching and physical preparation are the same as for any nuclear scan study (see section under "Brain Scanning").

• Inform the client of the scanning schedule and explain that scanning for each radionuclide administered takes about 1 hour.
• History should include signs and symptoms of any infectious process in any area of the body and results of recent diagnostic laboratory tests and procedures.

The client is placed on the examining table in a supine position and requested to remain still during the scanning. The indium In 111 oxine-labeled WBC is injected IV. The client is returned to or requested to return to the department in 24 hours for imaging of the liver, followed by posterior and anterior imaging of the abdomen, pelvis, and chest. Extremities can also be imaged, but they require a longer time to scan. After abscess inflammatory scanning, technetium Tc 99m sulfur colloid is injected, and a standard liver scan is obtained. These scans are compared to determine areas outside the liver and spleen that concentrate the radionuclide. This concentration indicates an abnormality and reveals a 90 percent accuracy for identifying an abscess/inflammatory site.

The procedure for labeling the WBCs with indium In 111 oxine is performed on a sample of the client's blood or a donor's blood if the client's WBC is low. The WBCs are separated from the blood and labeled and reinjected into the client. This process can take up to 3 hours, and the client can wait or be requested to return for administration of the radiopharmaceutical.

Nursing Care After the Procedure

Care and assessment after the procedure are the same as for any nuclear scan study (see section under "Brain Scanning").