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.
Images:
Anterior dynamic imaging (0-60 minutes)
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View second image(hs).
Anterior dynamic images after morphine administration.
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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.
Radiopharmaceutical:
3.2 mCi Tc-99m
mebrofenin i.v.
Findings:
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.
Discussion:
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.
Followup:
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:
- General ACR code: 72
- Gastrointestinal System:
7.285 "Hydrops, empyema, acute cholecystitis, intraperitoneal perforation of gallbladder"
References and General Discussion of Hepatobiliary Scintigraphy (Anatomic field:Gasterointestinal System, Category:Inflammation,Infection)
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Case number: hs010
Copyright by Wash U MO
