Indium-111 leukocyte appearance of Salmonella mycotic aneurysm

A 70-year-old man with a history of hypertension and diabetes mellitus was readmitted because of abdominal and back pain 2 weeks after laparoscopic cholecystectomy. A CT scan 7 days after readmission showed an enhancing infrarenal periaortic soft tissue mass. An In-111 labeled leukocyte scan performed the following day showed an abnormal focal increased uptake in the paravertebral region, suggesting a focus of infection or localized abscess. A repeat CT scan 4 days later showed enlargement of the periaortic soft tissue mass with rim enhancement, loss of aortic calcification, and poor visualization of the posterior wall of the aorta, suggesting a mycotic aneurysm. A mycotic aneurysms of the infrarenal aorta was confirmed on angiography the following day. In the meantime, the patient's blood culture became positive for Salmonella cholerasuis. The patient was taken to the operating room for debridement and primary repair on the 13th day of readmission. Postoperatively, he developed adult respiratory distress syndrome and died a month later. No autopsy was performed.