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False-negative morphine-augmented cholescintigraphy: a case of subacute gallbladder perforation
D M Achong1, J S Newman, E Oates
1Department of Radiology, New England Medical Center, Tufts University School of Medicine, Boston, Massachusetts 02111.
Summary
Morphine-augmented cholescintigraphy visualized gallbladder perforation and a related infected biloma. This imaging technique can help diagnose gallbladder issues, even with complications like perforation.
Area of Science:
- Gastroenterology
- Nuclear Medicine
- Diagnostic Imaging
Background:
- Acute cholecystitis is inflammation of the gallbladder, often caused by gallstones obstructing the cystic duct.
- Cholescintigraphy, also known as a HIDA scan, is a nuclear medicine imaging test used to evaluate gallbladder and bile duct function.
- Morphine augmentation can improve the accuracy of cholescintigraphy by stimulating gallbladder contraction.
Observation:
- A case of subacute gallbladder perforation was identified.
- An infected pericholecystic biloma, a collection of bile outside the gallbladder, was visualized.
- These findings were detected using morphine-augmented cholescintigraphy.
Findings:
- Morphine-augmented cholescintigraphy successfully visualized the gallbladder and an infected biloma resulting from subacute perforation.
- The study highlights that gallbladder perforation, while a complication, can sometimes lead to visualization of the gallbladder itself during cholescintigraphy.
- The presence of perforation may alter the typical presentation and interpretation of cholescintigraphy findings.
Implications:
- Gallbladder perforation should be considered in the differential diagnosis of abdominal pain, especially when imaging findings are atypical.
- Morphine-augmented cholescintigraphy can be a valuable tool in diagnosing gallbladder complications, including perforation and associated bilomas.
- Understanding the impact of perforation on cholescintigraphy is crucial for accurate diagnosis and management of acute cholecystitis, potentially preventing false-negative results.