Sharp bone marrow uptake of indium-111 leukocytes in a splenectomized patient with sclerosing cholangitis

Indium-111-labeled leukocyte imaging was performed on a splenectomized patient with end-stage cirrhosis. The scan demonstrated a small accessory spleen and markedly increased bone marrow activity. Given the lack of normally functioning spleen and liver, the most likely mechanisms accounting for this unusual pattern are: 1) redistribution of marginating labeled cells to the marrow and, 2) increased trapping by the marrow reticuloendothelial system of damaged cells normally sequestered by the spleen and liver.