Internal Jugular Vein and Cerebral Venous Sinus Infective Thrombophlebitis Detected With 99mTc-HMPAO White Blood Cell Scintigraphy

Abstract

A 35-year-old man with a history of renal transplant, congenital cystinosis, and diabetes was admitted to the hospital with fever, bilateral parotid gland swelling, and acute renal failure. He had 99mTc-HMPAO-WBC (99mTc-hexamethylpropyleneamineoxime white blood cell) imaging for the evaluation of possible parotitis. There was intense radiopharmaceutical uptake along the right internal jugular vein extending to the right sigmoid and transverse and superior sagittal sinuses, suggestive of infective thrombophlebitis or Lemierre syndrome. This study illustrates the value of 99mTc-HMPAO-WBC imaging as a tool for evaluating thrombophlebitis, particularly in patients with renal failure in whom contrast-enhanced CT may not be possible.

Re: Internal Jugular Vein and Cerebral Venous Sinus Infective Thrombophlebitis Detected With 99mTc-HMPAO White Blood Cell Scintigraphy

“…We read with interest the case report by Sistani et al, “Internal jugular vein and cerebral venous sinus infective thrombophlebitis detected with 99m Tc-HMPAO white blood cell scintigraphy” in Clinical Nuclear Medicine. 1 The authors’ suggestion that nuclear medicine may play a considerable role in the diagnosis of Lemierre syndrome is on point. Indeed, scintigraphic techniques hold the unique advantage of providing the necessary diagnostic criterion for septic thrombophlebitis, namely, the presence of local vascular inflammation 2 .…”