technetium-tc-99m-lidofenin and Biliary-Fistula

Bronchobiliary fistula (BBF) represents a rare but severe complication in patients affected by liver metastases. Although a clinical suspicion can arise when specific clinical signs, in particular biliptysis, are present, conventional imaging modalities often fail to confirm the diagnosis. We present a case of a patient affected by colon cancer with liver metastases previously treated with partial right-sided hepatectomy and multiple thermo-ablative treatments combined with chemotherapy, who manifested a septic fever associated with productive cough and biliptysis. Diagnosis of BBF was confirmed only by hepatobiliary scintigraphy with (99m)Tc-heptoiminodiacetic acid.

Topics: Aged; Bile; Biliary Fistula; Bronchial Fistula; Cautery; Cholangiopancreatography, Endoscopic Retrograde; Cholestasis; Colonic Neoplasms; Combined Modality Therapy; Drainage; Duodenum; Escherichia coli Infections; Female; Fever; Hepatectomy; Humans; Jaundice, Obstructive; Liver Neoplasms; Radionuclide Imaging; Stents; Technetium Tc 99m Lidofenin; Tomography, X-Ray Computed

Topics: Aged; Biliary Fistula; Bronchial Fistula; Female; Humans; Polycystic Ovary Syndrome; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Lidofenin

Bronchobiliary fistulas are rare, may result from infection with Echinococcus or Amebiasis, trauma, or hepatic malignancy, and present with biliptysis, the expectoration of bile. The authors present a 49-year-old woman who presented with frank biliptysis as a result of previously treated metastatic colon cancer to the liver. A hepatobiliary scan is the noninvasive diagnostic imaging test of choice for demonstration of such fistulas, and was useful in confirming the diagnosis in our patient.

Topics: Bile; Biliary Fistula; Bronchial Fistula; Female; Humans; Liver Neoplasms; Lung; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Lidofenin

The Tc-99m HIDA scan is a valuable study after liver transplantation, associated with other image techniques. We have used this technique as a reliable and objective diagnostic method for biliary fistula after removal of the T-tube in 5 liver transplantation patients with pain after T-tube removal. All five patients who developed fistula not only were diagnosed immediately but, furthermore, the surgical technique was indicated by the gammagraphic study. After this experience, we propose to remove the T-tube during the Tc-99 HIDA scan.

Topics: Biliary Fistula; Drainage; Gamma Cameras; Humans; Imino Acids; Liver Transplantation; Organotechnetium Compounds; Postoperative Complications; Radionuclide Imaging; Technetium Tc 99m Lidofenin

Topics: Biliary Fistula; Cholecystectomy; Drainage; Gastrectomy; Humans; Imino Acids; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin; Technetium Tc 99m Lidofenin

Repair of iatrogenic biliary stricture was carried out in 38 patients of whom five are now dead, three causally related. Thirty-one patients were followed up between August 1983 and March 1984 (mean time since repair 7.9 years). Fifty reparative operations were carried out, six patients first having a temporary end fistula performed. Cholangiography during cholecystectomy had been performed in only eight patients (21 per cent). All but one patient had gastroscopy and barium meal examination and the incidence of duodenal ulceration was 6.7 per cent and of oesophageal varices 5.6 per cent. Liver biopsies taken during the first reparative operation were normal in 5 per cent, obstructive in 65 per cent and cirrhotic in 30 per cent. Intra-operative cultures were mainly coliforms (66.7 per cent). Liver function tests were normal in 19 (61.3 per cent) but there was no correlation between abnormal values and clinical status. Twenty-nine patients (93.5 per cent) are now completely well. 99mTc HIDA scans, liver ultrasonography, intravenous cholangiography and BSP excretion were of limited value in planning further surgery. The most useful investigation before reoperation was transhepatic cholangiography.

Topics: Adult; Aged; Bile Ducts; Biliary Fistula; Child; Cholangiography; Cholecystectomy; Constriction, Pathologic; Female; Follow-Up Studies; Humans; Iatrogenic Disease; Imino Acids; Intraoperative Complications; Liver Function Tests; Male; Middle Aged; Reoperation; Technetium; Technetium Tc 99m Lidofenin; Time Factors; Ultrasonography

Topics: Aged; Biliary Fistula; Bronchial Fistula; Echinococcosis, Hepatic; Female; Humans; Imino Acids; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin

A case of bronchobiliary fistula diagnosed by 99mTc-HIDA cholescintigraphy is presented. The fistula caused by a stenosing tumor of the left hepatic duct would probably have been missed without the use of delayed views and body fluids counting which increased the specificity of scintigraphic findings.

Topics: Bile Duct Neoplasms; Biliary Fistula; Bronchial Fistula; Cholecystectomy; Cholestasis, Extrahepatic; Diagnosis, Differential; Female; Hepatic Duct, Common; Humans; Imino Acids; Mastectomy; Middle Aged; Postoperative Complications; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin