Hepatobiliary Scintigraphy:

A 33 year old man had a hepatobilliary scintigraphic examination because of intermittent discomfort and pain in the right upper abdominal region, especially after fatty meal.

Dynamic study (Tc99m, trimethyl-Br-IDA) showed normal size and shape of the liver. Prominent imaging of the common bile and the left hepatic ducts began in the 12th minute and filling of the gallbladder began in the 14th minute.

At 30 minutes the gallbladder was overextended and no intestinal excretion was noted. Therefore, the patient was given milk with egg yolk and the next part of the dynamic scintigraphy was started immediately.

During this study, the patient again experienced abdominal pain. At that time another cavity adjacent to the gallbladder appeared and disappeared several times in scintigraphic images. Later an abdominal ultrasound showed a septate gallbladder. Because no other abnormalities were found in the examination that followed, the authors believe the patient's difficulties were caused by dyskinesia of a septate gallbladder.

Dynamic Scintigraphy
Imaging of Septate Gallbladder

The dynamic study "after milk with yolk" :

A. Imaging the fourth minute shows the common bile duct, extended gallbladder and no distinct intestinal excretion.
B. The sixth-minute image shows filling of another cavity below the gallbladder and still no prominent intestinal activity.
C. At the eighth minute, the second part of the gallbladder disappeared.
D. The 12th minute image again shows filling of the second part of the gallbladder.
E. In the 14th minute, intestinal excretion is partially present and the gallbladder has emptied slightly.
F. The 18th minute image showed massive intestinal excretion a d significant emptying of both parts of the gallbladder.