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.
Images:
Anterior images every 5 minutes
through 60 minutes (each image scaled to its own maximum)
View main image(hs) in a separate image viewer
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.
Radiopharmaceutical:
6.5 mCi Tc-99m
mebrofenin i.v.
Findings:
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.
Discussion:
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.
Followup:
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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