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HEPATOBILIARY SCINTIGRAPHY
Authored By: Asif Moinuddin and Henry Royal.
Patient: 15 year old male
History:

15-year-old boy with grade 4 laceration of the liver as the result of recent ATV accident

Image Size:[small][as-submitted]

Fig. 1
60 minutes sequential images; Anterior images (5 minutes/frame)

Fig. 2
90 minutes sequential images; Anterior images (5 minutes/frame)

Fig. 3
60 and 90 minutes ; right lateral images

Fig. 4
24 hours delayed images; Anterior images(1 minutes/frame)

Fig. 5
Anterior image from 60 minutes data, acquired at different intensity
Image Size:[small][as-submitted]

Findings:

RADIOPHARMACEUTICAL: 2.68 mCi Tc-99m mebrofenin i.v.

 

FINDINGS:

 

Following intravenous administration of Tc-99m mebrofenin, sequential abdominal images were obtained through 90 minutes. There is prompt, uniform accumulation of the tracer by the liver. There is normal filling of the intrahepatic ducts, common bile duct and normal excretion of the tracer into the duodenum. There is an area of decreased tracer accumulation within the gall bladder (see figure 5), consistent with hemobilia as seen on recent CT examination. Otherwise, the gall bladder fills normally. In addition, delayed images were obtained 24 hours post radiotracer administration. No focus of increased activity is identified to suggest an active biliary leak.

Diagnosis:

DIAGNOSIS: No bile leak; scintigraphic evidence of hemobilia

General Discussion: FULL HISTORY:
15-year-old boy with grade 4 laceration of the liver as the result of recent ATV accident. His bilirubin level is 1.7 on 8/7/2006. Evaluate for biliary leak

DISCUSSION: Causes for hemobilia include posttraumatic (most common), cholelithiasis, acalculous inflammatory diseases, vascular disorders, and neoplasms. Clinically, hemobilia can present with biliary colic, jaundice and gastrointestinal bleeding.  The most useful diagnostic and therapeutic approach is to perform angiography. Computed tomography and ultrasound examinations are other alternatives.          


 

References:

REF: Hemobilia-Evolution of current diagnosis and treatment; West J Med. 1991 December; 155(6): 621–625. SW Merrell and PD Schneider                  

Comments:
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Additional Details:

Case Number: 83079Owner(s): Asif Moinuddin and Henry RoyalLast Updated: 02-07-2013
Anatomy: Gastrointestinal (GI)   Pathology: Trauma
Modality: Nuc MedAccess Level: Readable by all users, writable by NucMed Certifiers
Keywords: hsnm, hemobilia, trauma, biliary leakACR: 70000.29900

Case has been viewed 79 times.
Certified by Henry Royal on 04-18-2007

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