Hepatobiliary scintigraphy in a toddler with intrahepatic biliary leakage

Document Type : Case Report

Authors

Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

Abstract

A 2.5-year-old boy presented with abdominal pain and progressive jaundice three weeks after involvement in a car rollover accident. Initial abdominal ultrasonography demonstrated a hypoechoic lesion in segment VIII of the liver, raising suspicion for an intrahepatic biloma versus a resolving hematoma. To assess a possible biliary injury, hepatobiliary scintigraphy was performed. Although early dynamic images were nondiagnostic, posing a potential false-negative pitfall, extended delayed imaging up to six hours revealed gradual radiotracer accumulation within the lesion, consistent with an active intrahepatic bile leak leading to biloma formation. Given the patient’s symptomatic presentation and evidence of a slow yet active bile leak, percutaneous drainage was successfully performed. This case highlights the importance of differentiating active intrahepatic biloma from hematoma while facing a hypo-attenuating lesion on CT imaging in the post-traumatic setting, a distinction that can be effectively achieved using hepatobiliary scintigraphy with a standardized imaging protocol that includes prolonged delayed imaging and oblique projections to minimize false-negative interpretations caused by slow tracer accumulation or overlapping physiologic activity.

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References

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