False-negative morphine-augmented hepatobiliary scintigraphy with a rim sign

A patient with cholelithiasis and clinically suspected of acute cholecystitis underwent hepatobiliary scintigraphy that demonstrated initial nonvisualization of the gallbladder in association with a subtle rim sign, but subsequent gallbladder visualization after administration of intravenous morphine. After an 8-day period of medical management, an elective cholecystectomy was performed, which revealed a gangrenous gallbladder with a gallstone in the neck and full thickness necrosis. These results suggest that gallbladder visualization on morphine-augmented hepatobiliary scintigraphy should be interpreted cautiously in the presence of a rim sign because acute cholecystitis remains a possibility.