Presentation
35 year-old man with abdominal pain following laparoscopic cholecystectomy.
Patient Data
A hepatobiliary scan performed using 5 mCi of Tc99m-Choletec IV. Dynamic imaging performed in the anterior projection. 1 minute per frame for 60 minutes.
There is abnormal radiotracer seen in the gall bladder fossa representing leak, likely originating from the cystic duct. This subsequently tracks laterally and superior along the liver capsule.
A small amount of radiotracer is present in the small bowel, a normal finding.
Case Discussion
Unlike when evaluating for acute or chronic gall bladder disease, no special patient preparation is required when performing hepatobiliary scintigraphy for the assessment of a potential biliary leak.
A biliary leak is diagnosed when radiotracer is present outside its normal biodistribution (liver, biliary tree, and bowel). Most commonly, extravasated radiotracer is seen in the gallbladder fossa, right paracolic gutter or along the liver capsule.
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