Case Author(s): Sarah E. Reimer, MD and Henry D. Royal, MD , 06/18/99 . Rating: #D4, #Q5
Diagnosis: Common bile duct obstruction in a gravid patient
Brief history:
Colicky right upper quadrant abdominal pain
Images:
Sequential dynamic images
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Full history/Diagnosis is available below
Diagnosis: Common bile duct obstruction in a gravid patient
Full history:
Twenty-one year-old female with a 30-week gestation and two-year history
of colicky right upper quadrant abdominal pain. RUQ ultrasound
demonstrated multiple gallstones within the gallbladder, but no peri-
cholecystic fluid or gallbladder wall thickening.
Radiopharmaceutical:
Tc-99m mebrofenin i.v.
Findings:
There is prompt uptake of the radiopharmaceutical by the liver. On the
first images, a rim of increased activity is seen around the periphery
of the abdomen. This decreases in intensity over the course of the study.
No excretion is seen into the biliary system.
Discussion:
The patient's total bilirubin had increased from 0.9 on 6/9 to 2.1, which
is mildly elevated, on 6/11. The HIDA scan was requested to confirm the
diagnosis of acute cholecystitis prior to percutaneous cholecystotomy.
The prompt uptake of radiopharmaceutical by the liver is evidence of good
hepatic function. The lack of excretion into the biliary system suggests
a common bile duct obstruction.
The uterus receives approximately 20% of the cardiac output in the later
part of gestation, hence the increased blood pool activity on the early
images. As the tracer is extracted from the blood pool, this activity
decreases.
Followup:
The patient underwent percutaneous cholecystotomy and subsequently drained
600 cc of bile. Cultures of the bile were negative. The patient will
undergo elective cholecystectomy following delivery with contrast study
of the biliary system at that time.
ACR Codes and Keywords:
References and General Discussion of Hepatobiliary Scintigraphy (Anatomic field:Gasterointestinal System, Category:Metabolic, endocrine, toxic)
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Case number: hs016
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