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Nuclear Medicine

E3233. Hepatobiliary Scan: Thinking Outside the Biliary Tree—Unexpected Findings on Cholescintigraphy

Lin D,  Dalal I. Henry Ford Hospital, Detroit, MI

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Background Information: Cholescintigraphy is an important and commonly performed study in a busy nuclear medicine department. Although most often used to diagnose hepatobiliary diseases such as acute or chronic cholecystitis and biliary leak, crucial or unusual incidental findings that change patient management can be initially diagnosed.

Educational Goals/Teaching Points: The goal of this exhibit is to demonstrate unusual and unexpected findings initially diagnosed on cholescintigraphy. We present a series of pathology or surgically proven cases obtained from our nuclear medicine department with correlative radiographic imaging. We discuss key points in each case including the evaluation of radiotracer distribution in the bowel which may suggest pathology beyond the common bile duct, and attention to radiotracer distribution in the liver parenchyma which may reveal space occupying lesions.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques: Our case series of findings initially diagnosed on cholescintigraphy includes cholecystocolonic fistula, small bowel malrotation, differentiation of focal nodular hyperplasia from hepatic adenoma, hepatocellular carcinoma, biloma, choledochocele, and postoperative sequelae in the liver with vascular compromise and afferent loop syndrome. A set of challenge cases demonstrating incidental findings on cholescintigraphy are presented in conclusion, followed by correct answers.

Conclusion: Cholescintigraphy is a commonly performed study and awareness of the imaging appearance of various unexpected findings can allow the reader to create more accurate interpretations.