Diagnosing sternal wound infections with 99mTc-labeled monoclonal granulocyte antibody scintigraphy.
BACKGROUND
Postoperative mediastinitis is a serious complication of thoracic operations. The diagnosis can sometimes be difficult, especially in cases with subacute clinical presentation. The aim of this study was to assess the clinical use of granulocyte scintigraphy and tomography in the diagnosis of postoperative wound infection and mediastinitis.


METHODS
Twenty-nine patients after cardiothoracic operations were included, of whom 5 patients with a normal postoperative course formed the control group. We injected technetium 99m-monoclonal antigranulocyte antibodies and performed single-photon emission computed tomography after 4 and 20 hours.


RESULTS
Twenty-three patients had both the early and the later scan; the remaining 6 had only the early scan. Seven scans indicated infection: 3 cases of mediastinitis, 2 cases of superficial wound infection, 1 case of infection in a synthetic aortic graft, and 1 case of osteitis. All were verified by bacterial culture. There was one false-negative scan; this patient had only the early registration and then was explored.


CONCLUSIONS
This method when combined with the tomographic scan option is able to distinguish between deep and superficial infections. Two registrations must be made for optimal results.
Bitkover
C Y
CY
Department of Thoracic Surgery, Karolinska Hospital, Stockholm, Sweden.
Gårdlund
B
B
Larsson
S A
SA
Aberg
B
B
Jacobsson
H
H
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000911:Antibodies, Monoclonal; D000951:Antigens, Neoplasm; D015815:Cell Adhesion Molecules; D003937:Diagnosis, Differential; D005260:Female; D006098:Granulocytes / Q000276:immunology*; D006801:Humans; D008297:Male; D008480:Mediastinitis / Q000000981:diagnostic imaging*; D008562:Membrane Glycoproteins / Q000276:immunology*; D008875:Middle Aged; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013530:Surgical Wound Infection / Q000000981:diagnostic imaging*; D013667:Technetium; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*
D000911:Antibodies, Monoclonal; D000951:Antigens, Neoplasm; D015815:Cell Adhesion Molecules; D008562:Membrane Glycoproteins; D013667:Technetium