Case Author(s): Samuel Wang, M.D. and Barry A. Siegel, M.D. , 5/18/97 . Rating: #D2, #Q3
Diagnosis: Bile leak
Brief history:
46-year-old woman status
post laparoscopic cholecystectomy.
Images:
Sequential anterior 5-min images obtained from 0-60 minutes.
View main image(hs) in a separate image viewer
View second image(hs).
Delayed spot images.
View third image(ct).
CT of the abdomen.
Full history/Diagnosis is available below
Diagnosis: Bile leak
Full history:
46-year-old woman status
post laparoscopic cholecystectomy 14 days ago.
This operation was complicated by a bile leak, and repeat
surgery was subsequently performed with
placement of a surgical drain. The drain was
producing approximately 200-400 mL of bile
per day. The patient had ERCP performed,
which reportedly showed no evidence for a leak
from the extrahepatic biliary system.
Radiopharmaceutical:
3.1 mCi Tc-99m
mebrofenin i.v.
Findings:
Two persistent collections of
radiopharmaceutical accumulation are
identified. One focal collection is seen in the
region of the porta hepatis. A second larger
collection is seen overlying the left lobe of the
liver. It was initially uncertain whether these
foci of tracer accumulation could be in the gastrointestinal tract (in the
duodenum and stomach, respectively). Thus, delayed images
were obtained, and the patient was put through
a series of positional changes and also given
water to drink. Despite these maneuvers, the
activity in both locations did not change
appreciably with respect to intensity or shape.
These findings are most consistent with
bilomas.
Discussion:
Delayed imaging, positional
maneuvers, and having the patient drink water
are techniques that can be employed to help
distinguish gastrointestinal activity from
extraluminal bile collections.
Followup:
CT of the abdomen was
subsequently performed and confirmed the
presence of a large bilobed fluid collection
located in the gallbladder fossa and deep to the
left hepatic lobe.
ACR Codes and Keywords:
References and General Discussion of Hepatobiliary Scintigraphy (Anatomic field:Gasterointestinal System, Category:Effect of Trauma)
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Case number: hs011
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