LEAKING MYCOTIC-ANEURYSMS IDENTIFIED ON RBC VENOGRAPHY

An 11-year-old boy with bacterial endocarditis complicated by multiple septic emboli underwent Tc-99m RBC venography to investigate possible deep venous thrombosis of the lower extremities. The imaging technique involved in vivo RBC labeling combined with pedal intravenous injections of Tc-99m pertechnetate. The Tc-99m pertechnetate was administered in three boluses while venous flow images were acquired over the pelvis, thighs, and calves in sequence. Equilibrium blood pool images of the same areas were then acquired as needed. The equilibrium images suggested the presence of aneurysms in the right femoral and left popliteal arteries, which were seen to enlarge on delayed images. False aneurysms were identified on digital subtraction angiography, and surgical exploration revealed leaking mycotic aneurysms, culture-positive for Staphylococcus aureus, the offending organism found in previous blood and joint aspirate cultures.