technetium-tc-99m-sulfur-colloid and Cholecystitis

Each year approximately 52 million Americans are injured, of which 11 million require hospitalization and 110,000 die. This has an associated health care cost of 3 billion dollars. Hepatobiliary injuries have always constituted a significant area of involvement. They have become more easily detectable since the advent of technetium-99m analogs of iminodiacetic acid (IDA). Biliary leakage secondary to other causes, such as inflammation, neoplasm, and iatrogenic factors are also well demonstrated in a safe, simple, and rapid manner with radionuclide imaging. The relatively low patient radiation dose that is associated with these procedures permits follow-up studies when necessary.

Topics: Acute Disease; Aged; Bile Ducts; Child, Preschool; Cholecystitis; Evaluation Studies as Topic; Female; Gallbladder; Humans; Imino Acids; Liver; Male; Middle Aged; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Time Factors; Tomography, X-Ray Computed; Ultrasonography; Wounds and Injuries

The new 99mTc biliary scintigraphy agents are highly sensitive and specific in detecting biliary tract disease and use of them is the initial procedure of choice in evaluating patients with suspected acute cholecystitis. Other clinically useful indications are evaluation of biliary kinetics; evaluation of patients with suspected traumatic bile leakage, gallbladder perforation, or postsurgical biliary tract complications; and evaluation of patients with suspected biliary obstruction. In 99mTc we have a simple radiopharmaceutical of low radiation for evaluating congenital abnormalities and neonatal jaundice. In the Orient 99mTc cholescintigraphy is extremely important in evaluating patients with suspected intrahepatic stones. The overall advantages of this technique include availability, safety, simplicity, and accuracy. In addition, it may be performed in those patients who are allergic to iodinated contrast agents.

Topics: Acute Disease; Adolescent; Adult; Aged; Biliary Tract; Child; Cholecystitis; Diagnosis, Differential; False Positive Reactions; Gallbladder; Humans; Jaundice; Kinetics; Liver; Middle Aged; Postoperative Period; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

Increased hepatic activity surrounding the gallbladder fossa during Tc-99m SC liver imaging was observed. Subsequent Tc-99m IDA biliary imaging showed similar findings in the face of nonvisualization of the gallbladder--the classic "rim sign." Surgery confirmed the diagnosis of complicated acute cholecystitis. This case indicates that a rim sign may be seen with either Tc-99m SC or Tc-99m IDA imaging and may have the same diagnostic significance in both.

Topics: Acute Disease; Biliary Tract; Cholecystitis; Female; Humans; Imino Acids; Liver; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

A case of acute gangrenous cholecystitis due to cystic duct obstruction by a metastasis from malignant melanoma detected by cholescintigraphy is presented.

Topics: Acute Disease; Adult; Bile Duct Neoplasms; Cholecystitis; Cholestasis, Extrahepatic; Cystic Duct; Humans; Imino Acids; Male; Melanoma; Organometallic Compounds; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin; Technetium Tc 99m Sulfur Colloid

A focal hot spot in the liver, seen on radiocolloid imaging, has been reported in several conditions. A patient with acute cholecystitis who had a hot spot in the liver on both radiocolloid and hepatobiliary scintigraphy is described. The hepatobiliary finding disappeared following cholecystectomy.

Topics: Acute Disease; Aged; Cholecystitis; Female; Humans; Imino Acids; Liver; Organometallic Compounds; Radionuclide Imaging; Technetium Tc 99m Disofenin; Technetium Tc 99m Sulfur Colloid

Hepatobiliary scintigraphy has disclosed a host of intrahepatic and extrahepatic lesions which mimic gallbladder disease. Two cases of hepatic amebic abscess are reported in which the presentations masqueraded as acute cholecystitis. Correlative, noninvasive imaging rapidly diagnosed both cases and in 1 case identified a serious complication.

Topics: Adolescent; Adult; Cholecystitis; Diagnosis, Differential; Humans; Imino Acids; Liver Abscess, Amebic; Male; Organotechnetium Compounds; Radionuclide Imaging; Technetium; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray Computed; Ultrasonography

Topics: Acute Disease; Cholecystitis; Esophageal Diseases; Gastrointestinal Diseases; Gastrointestinal Hemorrhage; Humans; Imino Acids; Indium; Leukocytes; Meckel Diverticulum; Organotechnetium Compounds; Radioisotopes; Radionuclide Imaging; Stomach Diseases; Sulfur; Technetium; Technetium Tc 99m Diethyl-iminodiacetic Acid; Technetium Tc 99m Disofenin; Technetium Tc 99m Sulfur Colloid; Technology, Radiologic

Hepatobiliary scintigraphy with the 99mTc-labeled iminodiacetic acid derivatives has been shown to be useful in the evaluation of biliary tract diseases, especially for the diagnosis of acute cholecystitis. Little emphasis has been placed on the importance of the hepatic parenchymal image that occurs early in the imaging sequence. To determine what information can be obtained from the hepatic parenchymal image, a comparison was carried out of sulfur colloid and iminodiacetic acid images in 50 patients with focal defects. In 46 of 50 patients, the number and position of lesions on the two studies were similar, while in four patients the images were discordant. In addition to being very similar in lesion detection, the iminodiacetic acid scans also allowed more specificity in the later imaging (biliary phase) in 13 cases. The value of iminodiacetic acid derivatives in the evaluation of some biliary tract disorders has been established; considerable value can also be obtained by close inspection of the hepatic parenchymal image as well.

Topics: Adult; Bile Duct Diseases; Bile Ducts; Cholecystitis; Female; Humans; Imino Acids; Liver; Liver Neoplasms; Male; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Lidofenin; Technetium Tc 99m Sulfur Colloid; Time Factors

Absence of the right hepatic lobe following blunt abdominal trauma without surgical resection is reported. The usual site of the right hepatic lobe is demonstrated to be occupied by bowel by hepatobiliary imaging.

Topics: Abdominal Injuries; Atrophy; Cholecystectomy; Cholecystitis; Humans; Imino Acids; Intestines; Liver; Liver Cirrhosis; Male; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Time Factors; Wounds, Nonpenetrating