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Age: 84

Sex: Male

Indication: Left-sided chest pain, recent cholecystectomy

Radiotracer: Tc99m mebrofenin (an iminodiacetic acid analog)

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Case #1


Findings

  • Linear low level activity is seen around 40 minutes in the two right flank surgical drains. No discrete intraabdominal collections containing radiotracer
  • Prompt liver radiotracer uptake with normal excretion into the biliary tree and bowel in under 60 minutes
  • Normal flow imaging
  • Expected background distribution of radiotracer
  • Small amount of residual activity at the injection site in the left arm


Diagnosis

  • Postoperative bile leak with diversion of leaking bile into two right abdominal biliary drains
  • No large intra-abdominal collection of bile
  • No evidence of obstruction of the common bile duct

Sample Report

Positive for biliary leak, which is drained by the existing surgical drains.

No evidence of intra-abdominal bile collections.

No evidence of common bile duct obstruction.


Discussion


Images

Initial postoperative ultrasound in this patient showing a heterogeneous collection in the gallbladder fossa (blue arrows). External biliary drain was then placed by interventional radiology (red arrows). Normal early imaging with normal hepatic uptake (yellow arrows), normal excretion into the common bile duct (green arrows), and normal excretion into bowel (brown arrows). Faint linear activity along the right flank (green arrows) correlating with known surgical drains. After windowing, the radiotracer accumulation within the surgical drains is more apparent (green arrows). Normal activity in the urinary bladder (orange arrows). Infiltration at site of injection in the left arm (purple arrows).



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