Hepatobiliary Scan Findings in Chronic Cholecystitis

Abstract

Hepatobiliary scintigraphy, most often referred to as the HIDA scan, is often performed to assess cystic duct patency or occlusion in patients with suspected acute cholecystitis. The imaging diagnosis of chronic cholecystitis is generally made by sonographic demonstration of calculi in a setting of chronic recurrent abdominal pain or nonspecific dyspeptic symptoms. When a stone blocks the gallbladder neck or cystic duct, it precipitates an attack of acute cholecystitis that could be confirmed by performing the HIDA scan. In the course of performing HIDA studies, several incidental findings suggesting chronic cholecystitis may be encountered. Recognition of these suggestive patterns should increase the suspicion of chronic disease that can be further confirmed with sonography, gallbladder ejection fraction determination with sincalide cholescintigraphy, or other clinical findings. The material selected for this atlas is accumulated from many years of experience with HIDA scan. Illustration of the several scintigraphic patterns suggesting chronic rather than acute cholecystitis is presented to familiarize the reader with these findings. Correlation with clinical, radiologic, and pathologic findings is presented, as well. The illustrated findings, though not definitive, may explain the etiology of the underlying symptoms of chronic cholecystitis and direct further management.