LEARN NUCLEAR MEDICINE
Gastrointestinal · Case 07
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IMAGE PLACEHOLDER · Diagnostic study
Original study · Companion image placeholders
Clinical history
2-month old boy with new onset acholic stools and elevated liver enzymes.
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Severe neonatal hepatitis
Imaging Findings
Homogeneous uptake in the liver, delayed clearance of cardiac blood pool, and no excretion into GI tract. 3 hr delayed images were performed and demonstrate excretion into the GI tract.
Essential Facts
What is Severe neonatal hepatitis? Numerous liver diseases that mimic biliary atresia. They may be due to genetic, infections (culprits may include hepatitis A or B, rubella, CMV, or toxoplasma) or metabolic defects. Neonatal hepatitis-patent biliary system is patent; thus, 99mTc-iminodiacetic acid uptake and clearance are delayed.
Cholescintigraphy to differentiate between neonatal hepatitis and biliary atresia. Excretion into the biliary tract excludes biliary atresia.
Scan Information
Delayed blood pool clearance
Biliary clearance by 24 hours after Tc-99m HIDA injection
References
“Nuclear Medicine: The Requisites.” Nuclear Medicine: the Requisites, by Harvey A. Ziessman et al., Elsevier Saunders, 2014, pp. 147–148.
Zhou, Luyao, et al “Ultrasound for the Diagnosis of Biliary Atresia: A Meta-Analysis : American Journal of Roentgenology : Vol. 206, No. 5 (AJR).” American Journal of Roentgenology, 2016, www.ajronline.org/doi/10.2214/AJR.15.15336.
“Case 35.” Nuclear Medicine Case Review Series, by Harvey A. Ziessman, Elsevier, 2011, pp. 244.