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Scintigraphic gallbladder visualization with gangrenous acalculous cholecystitis.
Christopher Ananian1, Andrew Dunn, Vazrik Mansourian
1Nuclear Medicine, Department of Radiology, Hospital of Saint Raphael, Yale University School of Medicine, New Haven, CT 06511, USA. clananian@yahoo.com
Clinical Nuclear Medicine
|October 21, 2006
Summary
Hepatobiliary scintigraphy rarely yields false negatives for acute cholecystitis. This case highlights a normal study in gangrenous acalculous cholecystitis, emphasizing the need for clinical correlation.
Area of Science:
- Nuclear medicine
- Diagnostic imaging
- Gastroenterology
Background:
- Hepatobiliary scintigraphy, utilizing Tc-99m-labeled iminodiacetic acid agents (Tc-99m IDA), is a sensitive and specific diagnostic tool for acute cholecystitis.
- False-negative results in hepatobiliary scintigraphy for acute cholecystitis are exceptionally uncommon.
Observation:
- This report details a case of gangrenous acalculous cholecystitis with an apparently normal, nonmorphine-augmented hepatobiliary scintigraphy study.
- Clinical presentation, computed tomography, and ultrasound findings indicated a dilated gallbladder, prompting surgical intervention.
Findings:
- Pathologic examination confirmed acute gangrenous cholecystitis.
- Klebsiella pneumoniae was identified as the causative pathogen via gallbladder culture.
Implications:
- This case underscores the importance of integrating imaging findings with clinical and pathological data for accurate diagnosis.
- It suggests that even with advanced imaging techniques like hepatobiliary scintigraphy, a comprehensive diagnostic approach is crucial, especially in atypical presentations of acute cholecystitis.
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