LEARN NUCLEAR MEDICINE
Gastrointestinal · Case 03
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IMAGE PLACEHOLDER · Diagnostic study
Original study · Companion image placeholders
Clinical history
63 y/o female presents with a RUQ pain post laparoscopic cholecystectomy.
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Large biliary leak
Imaging Findings
Normal accumulation of activity by the liver. Beginning at 5 minutes, there is progressive accumulation around bowel loops which appear photopenic.
Essential Facts
What are some common causes of biliary leak?
Usually occurs most commonly post biliary tract surgeries or obstruction
Laparoscopic method is associated with a higher rate of bile duct injury than open cholecystectomy.
Other Causes: liver transplant or trauma
Patient Presentation
Nausea
Vomiting
Anorexia
Physical Exam Findings Findings
Right upper quadrant pain
Fever
Scan Information
Slow leaks typically seal spontaneously. One should repeat cholescintigraphy at a later time to ensure resolution.
You may need to delay views beyond 60 mins to accurately locate the leak
Faster leaks may require surgical intervention
While U/S and CT can detect fluid collections, it is with cholescintigraphy that one is able to determine if the fluid is biliary in origin
References
“Nuclear Medicine: the Requisites.” Nuclear Medicine: the Requisites, by Harvey A. Ziessman et al., Elsevier Saunders, 2014, pp. 152–153.