Thinking Outside the Biliary Tree: Unexpected Findings on Cholescintigraphy

Learning Objectives The goal of this exhibit is to demonstrate unusual and unexpected findings initially diagnosed on cholescintigraphy. We present a series of pathology/surgically proven cases obtained from our nuclear medicine department with correlative radiographic imaging. We will discuss key points in each case including the evaluation of radiotracer distribution in the bowel which may suggest pathology beyond the common bile duct, and attention to radiotracer distribution in the liver parenchyma which may reveal space occupying lesions.

Cholescintigraphy is an important and commonly performed study in a busy nuclear medicine department. Although most often used to diagnose hepatobiliary diseases such as acute or chronic cholecystitis and biliary leak, crucial or unusual incidental findings that change patient management can be initially diagnosed. Our case series of findings initially diagnosed on cholescintigraphy includes: Cholecystocolonic fistula, small bowel malrotation, differentiation of Focal nodular hyperplasia from hepatic adenoma, Hepatocellualr carcinoma, biloma, choledochocele,and post-operative sequelae in the liver with vascular compromise and afferent loop syndrome. A set of challenge cases demonstrating incidental findings on cholescintigraphy will be presented in our conclusion, followed by correct answers. Cholescintigraphy is a commonly performed study and awareness of the imaging appearance of various unexpected findings can allow the reader to create more accurate interpretations.