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

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

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