Presentation
Right upper quadrant pain.
Patient Data
Hepatobiliary scintigraphy performed using 4.9 mCi of Tc99m Choletec IV. Imaging performed every 6 minutes for 1 hour.
Exam shows homogenous liver uptake of radiotracer with prompt clearance from the blood pool (dashed oval).
The gall bladder fills normally starting at 24 minutes (arrow) excluding cystic duct obstruction.
There is normal biliary-to-bowel transit at 42 minutes (arrowhead).
Static images obtained immediately after the first 60 minutes of imaging confirm normal gall bladder filling.
Case Discussion
Normal hepatobiliary scintigraphy shows rapid uptake of radiotracer by the liver. The liver should appear homogeneous without areas of focally increased or decreased radiotracer activity.
The gall bladder should begin filling within 1 hour but is often seen within 30 minutes.
Likewise, radiotracer should transit into the small bowel within 1 hour.
Static images at the end of 1-hour can be helpful to confirm or exclude gall bladder filling. On a right lateral view, the gall bladder should move anterior (to the right). In contrast, potential false positives such as radiotracer in the duodenum or free pertechnetate in the right renal pelvis will move posteriorly (to the left). On an LAO view, conversely, the gall bladder moves laterally (to the right).
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