Falsely negative hepatobiliary scintigraphy studies in biliary atresia

Learning Objectives Educate the viewer regarding a potential false negative result owing to a less common subtype of biliary atresia, which negates the conventional claim in the literature that hepatobiliary scintigraphy is 100% sensitive in excluding the diagnosis of biliary atresia.

Summary: Hepatobiliary scintigraphy, although not highly specific in the diagnosis of biliary atresia, is conventionally thought to be 100% sensitive in excluding the diagnosis once bowel activity is seen. However, there are instances where scintigraphy will show bowel activity - thus presumably ruling out biliary atresia - when in fact the patient has biliary atresia, albeit a less common subtype of the disease. We present two cases of falsely negative scintigraphic results in two patients with biliary atresia proven by intraoperative cholangiogram and biopsy. We hope to make the viewer aware that the classic notion that scintigraphy is 100% sensitive in excluding biliary atresia when bowel activity is seen should be regarded with caution.