Clinical History
The patient is a 33-year-old female, status post orthotopic liver transplant and percutaneous liver biopsy,
who now presents with a right pneumobilia.
Technique
2.2 millicuries of Tc 99m Choletec was administered to the patient intravenously and multiple planar images
were obtained over the liver.
Findings
No prior studies are available for comparison.
1. There is rapid uptake of radionuclide in the liver with uptake into the
intrahepatic biliary duct by 35 minutes; however, no uptake is seen in
the common bile duct, and there is no emptying of radionuclide into the
small bowel.
2. There is a small area of increased uptake along the lateral border of
the liver by 35 minutes.
3. There is uptake of radionuclide above the right hemidiaphragm by 45
minutes.
4. Delayed images obtained four hours after injection of radionuclide
again show increased uptake along the lateral border of the liver, as
well as accumulation of radionuclide in the right hemithorax.
Impressions
THESE FINDINGS ARE SUGGESTIVE OF BILE LEAK WITH PROBABLE BILIARY/RIGHT
PLEURAL SPACE FISTULA. ERCP IS RECOMMENDED FOR FURTHER EVALUATION IF
CLINICALLY INDICATED.
Comments
Click here if you would like to view a cine of the baseline Hepato scan.
Click here if you would like to view a cine of the delayed Hepato scan.