Hepatobiliary scintigraphic findings in obstructed intrahepatic choledochal cyst before and after surgery

The authors describe a 10-week-old boy who presented with symptoms of progressive obstructive jaundice and abdominal distension. Clinical examination revealed gross hepatomegaly. A preoperative Tc-99m mebrofenin hepatobiliary study showed a large photopenic area involving the entire right lobe of the liver that did not communicate with the biliary system. Ultrasonography revealed a huge cystic mass with a few intracystic septae involving nearly the entire liver parenchyma. Under ultrasound guidance, a pigtail catheter was inserted into the cyst and produced free drainage of bile-stained fluid. Subsequently, an obstructed choledochal cyst was diagnosed clinically, and a right hepatectomy followed by a Roux-en-Y loop implantation on the raw surface of the left lobe were performed. Serial postoperative Tc-99m mebrofenin hepatobiliary studies showed marked improvement in liver function and biliary drainage with significant regeneration of the liver parenchyma.