CASE 125 A 53-year-old woman experiences continued abdominal distension on postoperative day 3 after undergoing laparoscopic cholecystectomy (Figs. 125.1 and 125.2). Fig. 125.1 Fig. 125.2 • The patient should take nothing by mouth between less than 24 hours and more than 4 hours before the test. • Immediately following the injection of 1.5 mCi of 99mTc-DISIDA, the patient is placed in a supine position beneath the gamma camera. • Continuous images acquired in a 256 × 256 matrix are divided into 1-minute frames. • Straight anterior views are obtained with a high-resolution, parallel-hole collimator. • Delayed static images may be acquired as necessary. Selected 1-minute dynamic images (Fig. 125.1) show the prompt uptake of tracer by the liver and subsequent appearance in the region of the gallbladder. Images later in the sequence (Fig. 125.2) show a vague focus of tracer concentration over the right lobe of the liver, lateral to the gallbladder. Also noted on these images is a change in the contour of the dome of the right lobe. • Biliary tract leak • Duodenal perforation
Clinical Presentation
Technique
Image Interpretation
Differential Diagnosis
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