Case Author(s): Samuel Wang, M.D. and Jerold Wallis, M.D. , . Rating: #D2, #Q3

Diagnosis: Acute acalculous cholecystitis

Brief history:

65-year old man status post aortic valve replacement and cecal perforation, now with fevers and abdominal pain.


Anterior static images over 60 minutes.

View main image(hs) in a separate image viewer

View second image(hs). Anterior static images over 30 minutes post morphine.

View third image(ct). CT gallbladder.

Full history/Diagnosis is available below

Diagnosis: Acute acalculous cholecystitis

Full history:

This 65-year old man is three weeks status post aortic valve replacement complicated by subsequent cecal perforation. The patient has been receiving total parenteral nutrition and now has fevers and abdominal pain. CT and ultrasonography demonstrated a distended gallbladder with sludge ,but no evidence of gallstones.


Tc-99m mebrofenin


Sincalide (0.02 ug/kg) was administered intravenously 30 minutes prior to radiopharmaceutical injection to promote initial emptying of the gallbladder. Static images obtained over the first hour post injection demonstrated good hepatic uptake with prompt excretion into the common bile duct and small bowel. There was no visualization of the gallbladder at 1 hour. Subsequently, 3 mg of morphine i.v. was administered. Additional imaging for 30 minutes again demonstrated nonvisualization of the gallbladder. These findings are most consistent with acute cholecystitis.


Sincalide is the synthetic C terminal octapeptide of CCK. Its use in this case was to promote initial gallbladder emptying in this patient with a distended gallbladder who had been on prolonged fasting with parenteral nutrition. Morphine augmentation was performed in this case to contract the sphincter of Oddi and thus promote biliary flow into the cystic duct instead of the common bile duct. Acalculous cholecystitis accounts for approximately 5-15% of all acute cholecystitis cases. It is seen most commonly in severely ill hospitalized patients with trauma, severe burns, sepsis, or recent surgery. The etiology is thought to be related to gallbladder ischemia or cystic duct obstruction by inflammatory edema, inspissated bile, or inflammatory debris.

ACR Codes and Keywords:

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

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Case number: hs007

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