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