Diagnosis by routine scintigraphy of hepatic reticuloendothelial failure before severe liver dysfunction

Objectives : The prognosis of hepatic reticuloendothelial failure is said to be poor. Scanning with the radiocolloid 99m Tc phytate is needed for diagnosis ; as a rule, only seriously ill patients are so investigated. We use 99m Tc phytate for liver scans of almost all inpatients with liver disease. This routine made diagnosis of a mild form or early stage of the disease possible. We evaluated the clinical findings of the five patients we have diagnosed, in an attempt to find why four survived. Methods : Radiocolloid scans were taken starting 20-30 min after the intravenous injection of 111 MBq of 99m Tc phytate. Hepatobiliary images were taken by use of 99m Tc pyridoxylidine-5-methyl tryptophan, and hepatic receptor images were taken by use of 99m Tc-labeled diethylenetriaminepentaacetic acid coupled with galactosyl human serum albumin. Results : The livers were not visible in the radiocolloid scans, so the diagnosis of hepatic reticuloendothelial failure was considered. In the two other imaging examinations, the livers were visible. The cause was identified as heavy alcohol intake in four cases and toluene hepatotoxicity in one case. Histological examinations showed cirrhosis in two patients ; the three other patients did not have cirrhosis. All five patients had anemia, and three had infections. One patient died of multiple organ failure, and the four other patients survived. Long-term observation by radiocolloid scanning was possible in one patient in whom radionuclide uptake into the liver rose as hepatic function improved. Conclusions: This disorder is associated with a temporary decrease in Kupffer cell function and hence is liable to be complicated by infection, which can result in death. If the cause is removed promptly, recovery is likely. There being a mild form of this disease, previously not generally diagnosed, probably accounts for the outcomes being good in all of our patients except the one patient with severe liver dysfunction at the time of diagnosis.