Case Author(s): Samuel Wang, M.D. and Tom R. Miller, M.D., Ph.D. , 9/22/96 . Rating: #D2, #Q3
Diagnosis: Biliary atresia.
Brief history:
2-week old girl with
conjugated hyperbilirubinemia.
Images:
Anterior static images over 60 minutes.
View main image(hs) in a separate image viewer
View second image(hs).
4 and 24 hour delayed images.
Full history/Diagnosis is available below
Diagnosis: Biliary atresia.
Full history:
This is a 2-week old infant
with elevated conjugated bilirubin and acolic,
gray stools.
Radiopharmaceutical:
Tc-99m
mebrofenin i.v.
Findings:
Sequential images obtained
over 60 minutes after injection demonstrate prompt uptake of the
radiopharmaceutical by the liver. There is no
evidence of excretion of the
radiopharmaceutical into the biliary system or
small bowel. Renal clearance into the bladder
was noted. Additional imaging obtained at 4
and 24 hours demonstrated no bowel activity.
Discussion:
In an infant with conjugated
hyerbilirubinemia, the primary differential
diagnosis is between biliary atresia and causes
of severe hepatic insufficiency such as neonatal
hepatitis. The diagnosis of biliary atresia
should be made early (preferably before three
months) so that surgery may be performed
before permanent liver failure occurs.
Typically, cases of neonatal hepatitis will
demonstrate poor hepatic uptake with
prolonged blood pool activity, although biliary-to-bowel transit is usually seen by 24 hours.
Cases of biliary atresia typically demonstrate relatively
good hepatic uptake with no evidence of
excretion into the bowel at 24 hours. While it
was not performed in this case, pretreatment
with phenobarbital (5 mg/kg/day for 5 days) to increase
biliary secretion by stimulating hepatic enzymes is freqeuently helpful to
minimize the possibility of a false-postivie study in a patient with a patent biliary system but poor excretion.
Followup:
Repeat scintigraphy with
phenobarbital pretreatment as well as liver
biopsy were both most consistent with biliary
atresia.
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: hs008
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