A 35-year-old woman with right upper quadrant pain undergoes hepatobiliary scintigraphy using Tc-99m mebrofenin. Images at 60 minutes show prompt hepatic uptake, excretion into the bowel, but non-visualization of the gallbladder. What does this finding indicate?

• A A normal study variant requiring no further action
• B Common bile duct obstruction
• C Chronic acalculous cholecystitis
• D Cystic duct obstruction, consistent with acute cholecystitis ✓

Explanation

On cholescintigraphy the gallbladder normally fills within 60 minutes. Non-visualization despite good hepatic extraction and bowel activity means the cystic duct is not patent, the hallmark of acute cholecystitis with sensitivity above 95%. Common bile duct obstruction would delay or prevent bowel activity entirely. Chronic cholecystitis typically causes delayed rather than absent gallbladder filling, and morphine augmentation may be needed before calling a study positive.

Reference: Mettler, Essentials of Nuclear Medicine Imaging, 8th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.