Presacral mass evaluated with computed tomography and whole-body Tc-99m white blood cell imaging

A 75-year-old woman was initially examined in the emergency department for fever, elevated leukocyte count, and new-onset right lower extremity tingling for 1 day. Physical examination revealed a large pelvic mass. Abdominal computed tomography (CT) revealed a large presacral mass. A biopsy showed that the mass was not malignant. A whole-body white blood cell (WBC)-labeled study was ordered for further evaluation. Both CT and the leukocyte examinations revealed findings consistent with a pelvic mass that extended posteriorly and laterally in both directions. The patient was taken to surgery and a diagnosis of perforated diverticulitis with an abscess located posterior to the rectum and dissecting laterally in the pelvis was confirmed. The patient recovered from surgery and is now symptom free.