technetium-tc-99m-mebrofenin and Common-Bile-Duct-Diseases

The availability of objective and quantitative diagnostic tests in recent years has allowed more precise documentation of biliary dyskinesia. Biliary dyskinesia consists of two disease entities situated at two different anatomical locations: sphincter of Oddi spasm, at the distal end of the common duct, and cystic duct syndrome, in the gallbladder. Both conditions are characterized by a paradoxical response in which the sphincter of Oddi and the cystic duct contract (and impede bile flow) instead of undergoing the normal dilatation, when the physiological dose of cholecystokinin is infused. Quantitative cholescintigraphy can clearly differentiate one disease entity from the other. The therapies of choice are sphincterotomy, sphincteroplasty or antispasmodics for sphincter of Oddi spasm and cholecystectomy for cystic duct syndrome. After quantitative cholescintigraphy, the final impression should identify the disease entity by name to assist the referring physician in making an appropriate therapeutic decision; a mere statement that a test is consistent with biliary dyskinesia is no longer sufficient.

Topics: Aniline Compounds; Biliary Dyskinesia; Cholecystokinin; Common Bile Duct Diseases; Cystic Duct; Gallbladder; Glycine; Humans; Imino Acids; Organotechnetium Compounds; Radionuclide Imaging; Radiopharmaceuticals; Sphincter of Oddi

A 2-month-old infant had jaundice that began 3 days after birth. The clinical features were suggestive of biliary obstruction. Tc-99m mebrofenin hepatobiliary imaging confirmed the diagnosis of spontaneous perforation of the common bile duct, and surgical intervention resulted in progressive recovery.

Topics: Aniline Compounds; Common Bile Duct Diseases; Glycine; Humans; Imino Acids; Infant; Organotechnetium Compounds; Radionuclide Imaging; Radiopharmaceuticals; Rupture, Spontaneous

Cholescintigraphy has proven useful in diagnosis of acute and chronic cholecystitis and evaluation of common bile duct obstruction. Common bile duct obstruction may be due to mechanical obstruction such as impact stone in the common duct or functional obstruction due to sepsis with intra-hepatic cholestasis or acute viral hepatitis. We present a cholescintigram of a patient with acute pancreatitis showing complete common bile duct obstruction.

Topics: Acute Disease; Aged; Aniline Compounds; Cholestasis, Extrahepatic; Common Bile Duct Diseases; Diagnosis, Differential; Gallstones; Glycine; Humans; Imino Acids; Male; Organotechnetium Compounds; Pancreatitis; Radionuclide Imaging