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Age: 44

Sex: Male

Indication: Right upper quadrant pain

Radiotracer: Tc99m Mebrofenin

IV morphine administered at 1 hour

Save ("V")

Case #2


Findings

  • Expected prompt uptake of tracer by the liver
  • Expected biliary activity before 30 minutes
  • Expected bowel lumen activity by 60 minutes
  • No activity in the expected location of the gallbladder even after morphine administration and delayed imaging
  • Faint curvilinear hepatic activity along the gallbladder fossa
  • Enterogastric reflux of bile


Diagnosis

  • Acute cholecystitis

Sample Report

Findings consistent with acute cholecystitis.


Discussion


Images

Imaging at 4 minutes shows clearance of radiotracer from the blood pool, uniform hepatic uptake, and small amount of activity within the extrahepatic biliary tree (green arrow). Imaging at 32 minutes shows bowel activity (brown arrows). Imaging at 56 minutes shows bowel activity to have moved into the proximal small bowel (brown arrows) and a rim sign (orange arrows) has become more apparent as radiotracer clears from the hepatic parenchyma. There is also reflux of bile into the stomach (pink arrow). Delayed imaging after morphine administration with still no radiotracer seen within the gallbladder. There is continued clearance of activity from the liver parenchyma (yellow arrows), and distal transit of the activity within the bowel (brown arrows). Green arrows show a more concentrated collection of radiotracer activity in the region of the distal common bile duct and duodenal bulb, of unclear significance.



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