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.


Anterior static images over 60 minutes.

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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.


Tc-99m mebrofenin i.v.


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.


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.


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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