Case Author(s): Scott Winner, M.D. and Keith Fischer, M.D. , 10/01/96 . Rating: #D3, #Q4

Diagnosis: Acute Cholecystitis

Brief history:

58-year old woman with abdominal pain.


Anterior dynamic imaging (0-60 minutes)

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View second image(hs). Anterior dynamic images after morphine administration.

View third image(hs). Right lateral view

Full history/Diagnosis is available below

Diagnosis: Acute Cholecystitis

Full history:

58-year old woman with abdominal pain, and a questionable calcification in the region of the gallbladder seen on an abdominal radiograph.


3.2 mCi Tc-99m mebrofenin i.v.


There is non-filling of the gallbladder. There is, however, a small focus of activity that projects anteriorly but is too small for a gallbladder.


The focus of activity seen anteriorly likely represents accumulation of tracer within the cystic duct. This finding is called the "dilated cyctic duct sign" and is a cause for false negative test results (other causes of false negative hepatobiliary studies include activity within an obstructed right renal collecting system, acalculous cholecystitis, a bile leak localized to the gallbladder fossa, acute passage of a gallstone prior to the study and rarely accumulation of activity within a choledochal cyst).

References : Coleman RE, et al. The Dilated Cystic Duct Sign. A Potential Cause of False Negative Cholescintigraphy. Clin Nucl Med 1984;9:134.


Surgery performed the day after hepatobiliary scintigraphy revealed two large gallstones (one in the body and one in the neck of the gallbladder). The patient had acute cholecystitis at surgery.

Major teaching point(s):

When confronted by a possible false negative hepatobiliary study, correlate the findings with results from other imaging tests. Obtaining right lateral or oblique static planar views is sometimes helpful. One should always review the study on the computer using the cine mode. Activity within the gallbladder will not fluctuate nor decrease during the course of the exam.

Differential Diagnosis List

See above.

ACR Codes and Keywords:

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

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Case number: hs010

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