Tc99m-HMPAO white blood cell scintigraphy: added value of SPECT/CT for infection diagnosis in cardiothoracic surgery

We report a case of a woman who came to our attention because of fever and a sternal fistula draining purulent fluid. Four years before, she had undergone cardiothoracic surgery to place a patch because of a myocardial rupture. Under suspicion of a deep mediastinal infection, a Tc99m-HMPAO white blood cell (WBC) scintigraphy was performed. The use of planar imaging and single photon emission computed tomography (SPECT/CT) imaging allowed the identification of a sternal infection, which involved the anterior mediastinum up to pericardium and diaphgram. SPECT/CT led to a precise diagnosis of a thoracic infection, providing the location and extent of the disease. This turned out useful to improve therapeutic strategies.