CASE REPORT 
Annals of Nuclear Medicine Vol. 11, No. 2, 151-153, 1997 
111In-chloride uptake in pulmonary aspergillosis 
Hitoya OHTA,* Akihito YONEZAWA,** Kaori NASU** and Masayuki SHINTAKU*** 
Departments of *Laboratories. **Internal Medicine, and ***Pathology, Osaha Red Cross Hospital 
Unusual pulmonary uptake of 111In-chloride (InCl3) was recognized in a patient with aplastic anemia. A chest radiograph showed infiltrative shadow concordant with llllnC13 uptake, and autopsy revealed pulmonary aspergillosis. To our knowledge, there is not an extensive literature on 111InCl3 uptake in pulmonary aspergillosis. 
Key words: 111In-chloride, lung, aspergillosis, aplastic anemia 
INTRODUCTION 
111IN-CHLORIDE (111InCl3) has been applied for scintigraphic examination of the bone marrow. 1-3 We report an aplastic anemia case in which unusual pulmonary uptake of 111InCl3 was recognized during bone marrow scintigraphy. 
CASE REPORT 
A 63-year-old male was found to have a "low blood count" at a hospital which the patient visited because of high fever, exertional dyspnea and purpura of the lower extremities. He was referred to our hospital for further evaluation. On admission, hematological values were as follows: erythrocyte count 196 x 104, leukocyte count 1,700 with 3% segmented neutrophils and 97% lymphocytes, thrombocyte count 5.2 x 104. Myelogram showed 13, 100 nucleated cells with 5.2% erythroid series and 92.5% lymphocytes. Chest radiograph showed no significant abnormalities. Therapeutic trials of steroids, granulocyte colony-stimulating factor and antibiotics did not result in favorable response. Bone marrow scintigraphy performed 48 hours after intravenous injection of 74 MBq of 111InCl3 showed marked decreased bone marrow uptake and abnormal pulmonary uptake (Fig. 1). Chest radiograph disclosed an infiltrative shadow concordant with 111InCl3 uptake (Fig. 2). 
The patient died 8 days after 111InCl3 scintigraphy due to respiratory failure. Autopsy revealed panmyelophthisis and pulmonary aspergillosis (Fig. 3). No extramedullary hematopoiesis was recognized in the lungs. 
DISCUSSION 
During studies of 111InCl3 as a tumor seeking agent, visualization of red marrow-containing bones was recognized.4 Thereafter, 111InCl3 has been applied as a useful bone marrow seeking agent.1-3 Except for lung tumors, pulmonary uptake of 111InCl3 has been reported in a case with idiopathic myelofibrosis5 and in a case with liver cirrhosis.6 In these cases, autopsy has revealed extramedullary hematopoiesis in the lungs, thereby supporting the usefulness of 111InCl3 for bone marrow imaging. In addition, after intravenous injection of 111InCl3, 111In binds to transferrin to form 111In-transferrin. And since 111In-transferrin is a stable blood-pool imaging agent, increased pulmonary uptake of 111InCl3 has been shown by dynamic scintigraphy in a canine model with pulmonary edema.7 
In the present case, autopsy revealed that infiltration of neutrophils or macrophages was not remarkable, but aspergillosis was invasive and associated with extensive anemic infarction of the lungs. The increase in vanule or capillary permeability of the lesion may contribute to 111InCl3 uptake, but the precise uptake mechanism was uncertain. 
In conclusion, unusual pulmonary uptake of 111InCl3 due to pulmonary aspergillosis was recognized in a patient with aplastic anemia. This case suggested the need to consider pulmonary aspergillosis in the differential diagnosis of pulmonary 111InCl3 uptake. 
ACKNOWLEDGMENTS 
The authors thank Mr. Masahiro Takayama, Mr. Takashi Tohryudani and Miss Yumiko Tsuda for their valuable assistance. 
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