Tuesday, November 9, 2010

" 25 year old male with history of fire arm injury 3 months back which resulted in perforation of stomach pancreas. Pt underwent repair & liver tear packing was also done which was later on removed. Patient developed intermittent fever, vomiting and cough. Patient was suspected to have liver abscess and an exploratory laprotomy was done but no abscess  was found. Now the vomiting and cough are more persistent with fever. Patient was sent to our department  for heptobiliary study. We planned a HIDA Scan with initial dynamic study of 30 min in anterior projection followed by the static spot views in anterior posterior and lateral projections.  

Shazia Fatima
Reference: Case of the month, published in EJNM & MI image of month in July 2010

A 22-year-old male patient suffered a grade IV liver injury with haemoperitoneum in a roadside accident 2 months earlier, for which laparotomy and biliary stenting were done. However, after a few days, the stent was passed during defecation. A week later, the patient developed intractable cough with copious expectoration of green sputum. Chest X-ray showed right-sided pleural effusion with consolidation in the right lower lobe. Sputum examination confirmed the presence of bile, which raised the suspicion of a biliobronchial communication. [99mTc]Mebrofenin hepatobiliary scintigraphy (HBS) showed preserved function in the right lobe of the liver and impaired uptake in the left lobe. Static planar images from 45 min to 2 h showed unobstructed biliary drainage into the intestine caudally, with a streak of tracer passing cranially into the chest cavity that subsequently mimicked the shape of the central airways. SPECT/CT scan identified activity in the bronchi and trachea as a result of bronchobiliary fistula subsequent to thoracoabdominal trauma . Clinical presentation is fever, dyspnoea, cough and biliptysis, which is considered pathognomonic of fistula formation. Planar HIDA is reported to be a reliable in this situation.

Shazia Fatima

Monday, November 8, 2010


Apparently, the nuclear medicine community in Pakistan is quite enthusiastic about discussing clinical cases as evidenced by the ongoing discussion. Why don't we start a Case of the Week, which I can put on the PJNM site and share with the group.

Here is one case for you lot to discuss.

Background: A 35-year-old man clinically suffering from iron deficiency anaemia, with normal gastroscopy and colonoscopy, was referred to the nuclear medicine department for a Meckel’ scintigram to investigate the possibility of  Meckel’s diverticulum as a source the patient’s blood loss. Following an intravenous injection sequential images of the abdominal and the pelvis were obtained for 30 minutes at 5-min intervals (see below).

Your comments and opinions on the scan are most welcome.