November 30, 2009

Nonvisualization of the Gallbladder with HIDA Scan


HIDA (Tc-99m hydroxy iminodiacetic acid) scan shows normal uptake in the liver with excretion into the extrahepatic bile duct (arrow) and in the bowel (arrowheads) at 25-30 minutes after radiotracer injection. Intravenous morphine was administered at 60 minutes. The images obtained up to 2 hours show no activity in the gallbladder.










Facts: HIDA scan
  • Also known as hepatobiliary scan
  • Liver uptakes HIDA and excretes it into bile that drains into the bowel
  • Normal activity should be seen immediately in the liver, at one hour in gallbladder and into the bowel
  • The scan can be done to help diagnose acute cholecystitis, postoperative bile leak
  • Morphine can be utilized to shorten the examination time for the diagnosis of acute cholecystitis if the gallbladder is not seen at 1 hour but the bile duct and bowel activity is visualized.
  • Cholecystokinin or fatty meal can be used to help diagnose chronic cholecystitis.

Findings on HIDA scan
Nonvisualization of gallbladder WITH bowel activity
  • Acute cholecystitis
  • Previous cholecystectomy
  • Non-fasting patient (including IV feeding)
  • Severe hepatic disease
  • Chronic cholecystitis (usually fills after 1 hour)
Nonvisualization of gallbladder WITHOUT bowel activity
  • Biliary obstruction of any cause
  • Severe hepatic disease
  • Opiates (because of their effect on the sphinctor of Oddi)
Our patient: acute cholecystitis confirmed at surgery

References:
1. Sharp PF, Gemmell HG, Murray AD. Practical nuclear medicine, 3rd edition, 2005.
2. Chapman S, Nakielny R. Aids to radiological differential diagnosis, 4th edition, 2003

No comments:

Post a Comment