LEARN NUCLEAR MEDICINE
Gastrointestinal · Case 08
Read the history, inspect the study, then reveal the teaching.
IMAGE PLACEHOLDER · Diagnostic study
Original study · Companion image placeholders
Clinical history
30-year-old male diagnosed with cirrhosis complicated by severe ascites and jaundice treated with liver transplant froma 15 year old. Patient later developed severe abdominal pain. HIDA scan was performed to evaluate for a biliary leak.
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Split-liver transplant
Imaging Findings
There is normal accumulation of activity by the liver. Beginning at 10 minutes, there is focal accumulation within the right hepatic lobe, activity is then noted to track along the right lateral abdomen and into the adjacent bowel loops. The activity tracking along the right lateral abdominal wall communicates with the bowel and is therefore inconsistent with a biliary leak.
Essential Facts
There are two types of split-liver grafting: extended right split and a left lateral split.
The right extended graft used in adults and the left lateral graft used in children (no larger than 30 kg). Alternatively, an extended right split, is performed in two adult recipients.
References
Singh, Ajay K., et al. “Imaging of Preoperative Liver Transplantation in Adults: What Radiologists Should Know.” RadioGraphics, 8 July 2011, pubs.rsna.org/doi/10.1148/rg.314105197.
Emre, S, and V Umman. “Split Liver Transplantation: an Overview.” Transplantation Proceedings, U.S. National Library of Medicine, Apr. 2011, www.ncbi.nlm.nih.gov/pubmed/21486620.
Cárdenas, Andrés, et al. “The Role of Endoscopy in Biliary Complications after Liver Transplantation.” UpToDate, 2018, www.uptodate.com/contents/the-role-of-endoscopy-in-biliary-complications-after-liver-transplantation?search=cholescintigraphy%2Bafter%2Bliver%2Btransplant&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1.