Case Author(s): Mike Roarke, M.D. and Henry D. Royal,M.D. , 3/8/96 3/8/96 . Rating: #D3, #Q4

Diagnosis: Congenital Common Bile Duct Obstruction.

Brief history:

2-month old boy with new onset acholic stools and elevated GGT


Anterior images of the abdomen.

View main image(hs) in a separate image viewer

View second image(us). Sonogram showing gallbladder.

View third image(fl). Transhepatic cholangiogram.

View fourth image(fl). After placement of biliary catheter.

Full history/Diagnosis is available below

Diagnosis: Congenital Common Bile Duct Obstruction.

Full history:

2-month old boy with new onset acholic stools and elevated liver enzymes. This examination was requested to evaluate for evidence of bile duct obstruction or atresia.


Tc-99m mebrofenin i.v.


Hepatobiliary scintigraphy was performed. At 5 minutes post injection, there is prompt accumulation of tracer by the liver and some residual blood pool activity within the heart. At 60 minutes, the heart blood pool activity is resolved and the liver demonstrates no significant excretion into the biliary tree. At 24 hours, there is still no biliary tree visualization, no significant small bowel activity, and there is some tracer within the urinary bladder indicating vicarious excretion through the kidneys. A sonographic image confirms the presence of a gallbladder as a fluid filled structure adjacent to the liver. Transhepatic cholangiogram demonstrates a rounded mass-like structure producing obstruction to contrast passage via the common bile duct. A follow- up image demonstrates that a catheter was passed beyond this obstruction and into the duodenum.


Following placement of the biliary catheter, the obstructing lesion in the distal common bile duct was no longer seen. It is felt that this patient likely had a congenital web within the common bile duct, which produced the obstruction to bile flow. No evidence of a biliary calculus was found.

Differential Diagnosis List

In cases such as this the major differential diagnosis includes biliary atresia vs neonatal hepatitis. The prompt hepatic uptake of tracer argues against neonatal hepatitis, however. As this case demonstrates, congenital bile duct obstruction can have an appearance indistinguishable from that of biliary atresia on hepatobiliary scintigraphy.

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: hs005

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