Hepatobiliary scan with delayed gallbladder visualization in a case of acute appendicitis

Area of Science:

• Radiology
• Gastroenterology
• Abdominal Imaging

Background:

• Acute abdominal pain is a common clinical presentation.
• Hepatobiliary scintigraphy (HIDA scan) is frequently used to evaluate gallbladder function and diagnose cholecystitis.
• Standard HIDA scan protocols typically involve a 60-minute imaging window.

Observation:

• A 40-year-old woman presented with acute epigastric pain and vomiting, with pain migrating to the periumbilical region.
• Initial 60-minute Tc-99m disofenin hepatobiliary scan did not visualize the gallbladder.
• Physicians presumed acute cholecystitis based on the non-visualization.
• A delayed 75-minute view revealed gallbladder filling.

Findings:

• Non-visualization of the gallbladder on a 60-minute HIDA scan can be a false positive for acute cholecystitis.
• Delayed imaging (2-24 hours) is crucial when the gallbladder is not seen initially.
• Gallbladder visualization on delayed views excludes cystic duct obstruction.

Implications:

• Misdiagnosis of acute cholecystitis can be avoided by employing delayed HIDA scan views.
• Excluding cystic duct obstruction directs further investigation towards alternative diagnoses like pancreatitis, acalculous cholecystitis, or appendicitis.
• This case highlights the importance of adhering to extended imaging protocols in hepatobiliary scintigraphy for accurate abdominal pain evaluation.