Tc-99m-human serum albumin scans in children with protein-losing enteropathy

Protein-losing enteropathy (PLE) can be diagnosed scintigraphically using T c-99m-human serum albumin (HSA) scans. Methods: To evaluate the usefulness of this method in detecting enteric protein loss, we retrospectively review ed the Tc-99m-HSA scans of 18 children presenting consecutively with PLE. R esults: Enteric Tc-99m-HSA uptake was noted in 12 patients (8 boys, 4 girls ) with a mean age of 7.4 y. Early dynamic images showed abdominal uptake th at was most likely in the small bowel in 91% of the scans. Delayed images s howed abnormal accumulation that was localized in the colon in 73% and in t he small bowel in 27% of the scans. A 4-mo follow-up scan obtained in 3 pat ients showed reduced HSA uptake after a high-protein, low-fat, medium-chain triglyceride oil-based diet and fat-soluble vitamins. Mean serum albumin, total protein, gammaglobulin, and calcium levels were significantly decreas ed. Ten patients (from 4 families) were diagnosed to have primary intestina l lymphangectasia. One patient had active Salmonella enterocolitis, and 1 h ad giardiosis. Tc-99m-HSA was normal in the remaining 6 patients (3 boys, 3 girls) with a mean age of 3.5 y (range, 2-5 y). Mean serum albumin, total protein, gammaglobulin, and calcium levels were less decreased than those o f the first group. Five of these patients had primary intestinal lymphangac tesia (associated with infantile systemic hyalinosis in 1 patient). The rem aining patient had normal duodenal biopsy, and the cause of protein loss re mained unknown. Conclusion: The Tc-99m-HSA scan is useful in the evaluation of children with PLE, especially those with severe hypoproteinemia and hyp oalbuminemia, presumably reflecting a high rate of protein loss.