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


Sequential dynamic images

View main image(hs) in a separate image viewer

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.


Tc-99m mebrofenin i.v.


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.


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.


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)

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: hs016

Copyright by Wash U MO