Case Author(s): Charles Pringle, M.D. and Jerold Wallis, M.D. , 06/03/96 . Rating: #D2, #Q3

Diagnosis: Biliary Leak

Brief history:

Abdominal pain following T-tube removal.


Anterior images every 5 minutes through 60 minutes (each image scaled to its own maximum)

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View second image(fl). Endoscopic Retrograde Cholangiopancreatography

Full history/Diagnosis is available below

Diagnosis: Biliary Leak

Full history:

50-year old man status post orthotopic liver transplant for hepatitis-B and hepatitis-C. On the day before this study, the patient had his T-tube removed. Later that day, he developed severe abdominal pain. Rule out biliary leak.


6.5 mCi Tc-99m mebrofenin i.v.


There is normal accumulation of activity by the liver. However, beginning at 20-25 minutes, there is an abnormal accumulation of tracer extending superiorly and laterally. There is a second abnormal area of accumulation of tracer extending medially along the anteroinferior margin of the left hepatic lobe. These findings are consistent with a biliary leak.


This study illustrates the utility of hepatobiliary imaging in evaluating for biliary leak, after surgery (e.g. endoscopic cholecystectomy) or after trauma.

On the scintigraphic study, the relative magnitude of the leak may be judged relative to the amount of bile passing normally into bowel. If the leak is relatively small, conservative management will frequently be employed.


Later on the same day, the patient underwent an ERCP procedure, which also demonstrated leakage of contrast material from an area above the native cystic duct near the surgical anastomosis. Subsequently, an intrahepatic biliary stent was placed and the patient did well.

ACR Codes and Keywords:

References and General Discussion of Hepatobiliary Scintigraphy (Anatomic field:Gasterointestinal System, Category:Misc)

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Case number: hs006

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