Acute cholecystitis, biliary obstruction, and biliary leakage
Section snippets
Acute cholecystitis
ACUTE ABDOMINAL pain is a common emergency room complaint and not uncommon in ill, hospitalized patients. Its etiology must be differentiated from various other acute abdominal conditions (eg, acute appendicitis, perforated/penetrating duodenal or gastric ulcer, acute pancreatitis, small bowel obstruction, lower lobe pneumonia, ureteral calculus). The pathophysiology of biliary colic and acute cholecystitis begins with cystic duct obstruction. Obstruction to venous and lymphatic outflow
Optimal methodology
Attention to technique and methodology maximizes the accuracy of cholescintigraphy. The radiopharmaceutical dose can be increased in patients with hepatic insufficiency.40 Although the larger dose will increase the count rate, it will not improve the target-to-background ratio. At times, there is diagnostic uncertainty caused by the overlap of anatomy and biliary flow of the gallbladder, biliary ducts, and small bowel in the anterior view. Right lateral and left anterior oblique views are often
Biliary obstruction
Common causes for biliary obstruction include malignancy, choledocholithiasis, and inflammatory stricture. Much less common causes are sclerosing cholangitis, choledochal cyst, hemobilia, duodenal diverticulum, echinococcus, and ascariasis. Stone formation is related to the secretion of lithogenic bile. Approximately 90% of calculi form in the gallbladder and pass into the biliary duct via the cyst duct. A minority of calculi form de novo outside the gallbladder in the intrahepatic or
Bile leaks
Bile leaks after post-cholecystectomy are common. Small quantities of leakage after cholecystectomy do not usually lead to serious medical complications. Gilsdorf et al. performed cholescintigraphy routinely 2 to 4, hours after open cholecystectomy.134 Bile leaks were detected in 44% of patients. Most leaks were not clinically significant. The cause of bile leakage after cholecystectomy is often caused by surgical transection of small biliary radicles entering directly into the gallbladder bed
References (163)
- et al.
Diagnostic utility of cholescintgiraphy and ultrasonography in acute cholecystitis
Am J Surg
(1981) - et al.
Role of cholecystokinetic agents in 99mTc-IDA cholescintigraphy
Semin Nucl Med
(1981) - et al.
Increased risk of cholelithiasis with prolonged total parenteral nutrition
Am J Surg
(1983) - et al.
Does total parenteral nutrition induce gallbladder sludge formation and lithiasis
Gastroenterology
(1983) - et al.
Cholescintigraphy in the critically ill
Am J Surg
(1988) - et al.
Role of cholescystokinetic agents in 99mTc-IDA cholescintigraphy
Semin Nucl Med
(1981) CholescintigraphyClinical indications and proper methodology
Radiol Clin N Am
(2001)- et al.
Evolving changes in the pathogenesis and treatment of perforated gallbladder
Am J Surg
(1985) - et al.
The natural history of silent gallstonesThe innocent gallstone is not a myth
N Engl J Med
(1982) - et al.
A prospective analysis of 1518 laparoscopic cholecystectomies
N Eng J Med
(1991)
Ultrasonic evaluation of patients with acute right upper quadrant pain
Radiology
A test for patency of the cystic duct in acute cholecysitis
Ann of Int Med
Diagnosis of hepatobiliary disease by 99m Tc-HIDA cholescintigraphy
Radiology
The validity of 99mTc-pyridoxylidene glutamate cholescintigraphy as a diagnostic test for cholecystitis
Clin Nucl Med
Rapid and accurate diagnosis of acute cholecysitis with 99m Tc-IDA cholescinigraphy
AJR Am J Roentgenol
The role of HIDA/PIPIDA scanning in diagnosing cystic duct obstruction
Ann Surg
Hepatobiliary scanning in the diagnosis of acute cholecysitis
Arch Surg
Rapid evaluation of acute abdominal pain by hepatobiliary scanning
JAMA
Spectrum of 99mTc-IDA cholescintigraphic patterns in acute cholecystitis
Radiology
Suspected acute cholecystitis. Comparison of hepatobiliary scintigraphy versus ultrasonography
Clin Nucl Med
Hepatobiliary scanning with 99mTcPIPIDA in acute cholecystitis
Radiology
A comparison of radionuclide hepatobiliary imaging and real-time ultrasonography for detection of acute cholecystitis
Radiology
Prospective evaluation of 99mTc-IDA cholescintigraphy and gray-scale ultrasound in the diagnosis of acute cholecystitis
Radiology
Cholecystitis. Prospective evaluation of sonography and 99mTc-HIDA cholescintigraphy
AJR Am J Roentgenol
Evaluation of acute right upper quadrant painSonography and 99mTc-PIPIDA cholescintigraphy
AJR Am J Roentgenol
Hepatobiliary scintigraphy is superior to abdominal ultrasonography in suspected acute cholecystitis
Surgery
Influence of scan and pathologic criteria on the specificity of cholescintigraphyConcise communication
J Nucl Med
The normal fasting and postprandial diisopropyl-IDA Tc-99m hepatobiliary study
Radiology
Biliary scanning with Tc-99, pyridoxylideneglutamate—the effect of food in normal subjectsConcise communication
J Nucl Med
Radionuclide hepatobiliary imagingNon-visualization of the gallbladder secondary to prolonged fasting
J Nucl Med
The value of hepatobiliary scans in fasted patients receiving total parenteral nutrition
Surgery
Gallbladder emptying stimuli in obese and normal-weight subjects
Hepatology
Predictive value of an abnormal hepatobiliary scan in patients with severe intercurrent illness
Radiology
Increased risk of gallstones in children receiving total parenteral nutrition
Pediatrics
Effect of fasting and parenteral alimentation on PIPIDA scintigraphy
Dig Dis Sci
PIPIDA scintigraphy for cholecysitisFalse positive in alcholism and total parenteral nutrition
AJR Am J Roentgenol
The need for routine delayed radionuclide hepatobiliary imaging in patients with intercurrent disease
Radiology
HIDA scanning in gallbladder diseae
Br J Radiol
Differential diagnosis of jaundice by Tc-99m IDA hepatobilary imaging
Clin Nucl Med
Tc-99m IDA imaging in the differential diagnosis of acute cholecystitis and acute pancreatitis
Radiology
Visualization of the biliary tract with Tc-99m HIDA in acute pancreatitis
Gastroenterology
Biliary scintigraphy in acute pancreatitis
Radiology
The clinical role of technetium-99m iminodiacetic acid cholescingraphy
Nonvisualization of the gallbladder by 99mTc-HIDA cholescinitigraphy as evidence of cholecystitis
CMAJ
The “water-ida”A simple means to separate duodenal from gallbladder activity on cholescintigraphic studies
Eur J Nucl Med
Differentiation of the gallbladder from the duodenum on cholescintigrams by dynamic display
Radiology
The dilated cystic duct signA potential cause of false-negative cholescintigraphy
Clin Nucl Med
Delayed biliary-to-bowel transit in cholescintigraphy after cholecystokinin treatment
Radiology
Gallbladder response to a second dose of cholecystokinin during the same imaging study
Eur J Nucl Med
Normal values for sincalide cholescintigraphyComparison of two methods
Radiology
Cited by (41)
A novel biomarker in acute cholecystitis: YKL-40
2023, Asian Journal of SurgeryCitation Excerpt :One of the most common reasons for admission to the emergency room is abdominal pain. Approximately 60% of patients with acute abdominal pain have gallstones.1 Acute cholecystitis is a disease that occurs as a complication of gallstones or as a result of acute inflammation of the gallbladder without gallstones.2–4
Chapter 17 - Role of nuclear medicine in diagnosis and management of hepatopancreatobiliary disease
2017, Blumgart's Surgery of the Liver, Biliary Tract and Pancreas: Sixth EditionAcute Cholecystitis and Biliary Obstruction
2016, Diagnostic Imaging: Nuclear MedicineUltrasonographic evaluation of right upper quadrant pain in Emergency Departments
2011, Ultrasound ClinicsNuclear Imaging
2010, GI/Liver Secrets Plus: Fourth EditionNuclear Medicine Hepatobiliary Imaging
2010, Clinical Gastroenterology and HepatologyCitation Excerpt :The reason is that HIDA imaging detects the initiating pathophysiologic event, obstruction of the cystic duct, resulting in nonvisualization of the gallbladder because the radiotracer cannot enter the gallbladder, while ultrasonography detects secondary (gallbladder wall thickening, pericholecystic fluid), and nonspecific findings (gallstones, ultrasonic Murphy's sign). Seven investigations have directly compared the accuracy of cholescintigraphy and ultrasonograpy for the diagnosis of acute cholecystitis.3 These studies showed superior accuracy for cholescintigraphy with an overall sensitivity and specificity of 97% and 94% for cholescintigraphy and 70% and 86% for ultrasonography.