Case Author(s): J. Wallis , 7/21/95 . Rating: #D1, #Q3

Diagnosis: Normal hepatobiliary study

Brief history:

28 year old woman with a 6 month history of abdominal pain.

Images:

Sequential 2 minute images of the anterior abdomen. Images are scaled to the maximum pixel in each image; images in the last row are shown at greater intensity to show tracer in the bowel (resulting in grey-scale overflow elsewhere in the image)

View main image(hs) in a separate image viewer

View second image(hs). Images following administration of sincalide, displayed as sequential 2 minute frames for 30 minutes.

View third image(hs). A plot of activity in the region of the gallbladder after sincalide administration.

Full history/Diagnosis is available below

Diagnosis: Normal hepatobiliary study

Findings:

There is prompt, uniform accumulation of the tracer by the liver. There is normal filling of the intrahepatic ducts, common bile duct and gallbladder and normal excretion of the tracer into the duodenum.

There was prompt contraction of the gallbladder following administration of 0.02 ug/k of sincalide by slow intravenous infusion. The calculated gallbladder ejection fraction was 50%. The sincalide infusion did not reproduce the patient's pain.

Discussion:

Hepatobiliary imaging is a sensitive and specific test for acute cholecystitis. Rapid clearance of Tc-99 mebrofenin from the blood pool can be seen in this patient with normal hepatic function. Prompt filling of the gallbladder makes acute cholecystis quite unlikely.

In this study, sincalide was administered to evaluate for chronic acalculus cholecystis. The normal response to sincalide argues against this disorder. However, the sensitivity and specificity of this "CCK HIDA" study is currently under debate in the literature.

Major teaching point(s):

In a normal hepatobiliary study, the gallbladder and bowel will be visualized during the first hour of imaging.

ACR Codes and Keywords:

References and General Discussion of Hepatobiliary Scintigraphy (Anatomic field:Gasterointestinal System, Category:Normal, Technique, Congenital Anomaly)

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Case number: hs003

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