© 2012 Must See Radiology

• History
• View Case
• Findings
• Diagnosis
• Check Out

• History
• View Case
• Findings
• Diagnosis
• Check Out

Key Image

Two anterior scintigraphic images obtained at 60 mins post radiotracer injection and 30 minutes post-morphine injection

Key Findings

The gallbladder is not visualized at 60 minutes post radiotracer injection and 30 minutes post morphine injection (90 post radiotracer injection). Radiotracer activity in the bowel is present in both images.

• History
• View Case
• Findings
• Diagnosis
• Check Out

Diagnosis

Acute Cholecystitis

Discussion

Hepatobiliary imaging is more sensitive and specific than US for evaluation of cholecystitis. It provides functional information regarding the emptying of the gallbladder and patency of the cystic duct.

Positive study when:
- GB not seen during first 60 mins(83%)
- GB not seen during first 4 hours (99% spec)
- Perpericholecystic rim sign (34% sens) (peripheral liver inflammation)

When the NM technologist presents the case to you at 60 minutes post-radiotracer injection, you have 2 options when the gallbladder is not seen. You may either inject IV morphine or wait an additional 4 hours to re-evaluate the gallbladder.

Negative if:
- GB identified within 4 hr of tracer injection or
- GB identified within 45 min after morphine injection

Morphine IV dose = 0.04 mg / kg over 1-2 minutes. The average dose should be ~ 3mg total for a patient weighing 165 lbs / 75 kg.

References / Resources

Additional Information:

1. Dahnert*: 713
2. Primer*: 166
3. Related Article:

   O'Connor, OJ. "Imaging of Cholecystitis." April 2011 AJR 196:4, W367-W374.

• History
• View Case
• Findings
• Diagnosis
• Check Out

Feedback

Any feedback regarding this case can be emailed to Tony@mustseeradiology.com