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.


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.


3.1 mCi Tc-99m mebrofenin i.v.


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.


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.


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)

Search for similar cases.

Edit this case

Add comments about this case

Read comments about this case

Return to the Teaching File home page.

Case number: hs011

Copyright by Wash U MO