technetium-tc-99m-disofenin and Bronchial-Fistula

Bile leakage into the thoracic cavity is a rare complication of invasive cancer. A 12-year-old boy was diagnosed with undifferentiated sarcoma of the right lobe of the liver invading the diaphragm. An extended right hepatectomy and total resection of the mass was performed, leaving a patchy tumoral invasion at the anterior diaphragmatic surface. Surgery was followed with a combined chemotherapy regimen. In the sixth postoperative month, he was readmitted with bilious expectoration. Tc-99m mebrofenin hepatobiliary scintigraphy revealed radiotracer accumulation in the right hemithorax. Bile leakage into the right thoracic cavity was diagnosed based on the hepatobiliary scintigraphic findings. For this patient; hepatobiliary scintigraphy, which is routinely used to visualize the liver and biliary tree, provided a noninvasive mean for the precise diagnosis of a bronchobiliary fistula. The fistula was then confirmed and corrected with surgery. The patient recovered uneventfully.

Topics: Bile; Biliary Fistula; Bronchial Fistula; Child; Hepatectomy; Humans; Liver Neoplasms; Male; Radionuclide Imaging; Radiopharmaceuticals; Sarcoma; Technetium Tc 99m Disofenin

We present a case of a bronchobiliary fistula initially detected by hepatobiliary scintigraphy. The patient developed bilioptysis 18 mo after undergoing a right hepatic lobectomy and resection of the common bile duct for cholangiocarcinoma. The procedure was complicated by the development of a subphrenic abscess that required percutaneous biliary drainage.

Topics: Adult; Bile; Biliary Fistula; Biliary Tract; Bronchial Fistula; Drainage; Female; Humans; Imino Acids; Liver; Organotechnetium Compounds; Postoperative Complications; Radionuclide Imaging; Subphrenic Abscess; Technetium Tc 99m Disofenin

A case is described in which technetium-99m-di-isopropyl-iminodiacetic acid imaging was used to trace the passage of bile from its site of leakage into an amoebic liver abscess, through a fistulous tract connecting the liver abscess with an abscess in the right lower lobe of the lung, and into the upper respiratory tract.

Topics: Adult; Biliary Fistula; Bronchial Fistula; Female; Humans; Imino Acids; Liver; Liver Abscess, Amebic; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin