Right upper quadrant pain with normal hepatobiliary ultrasound: can hepatobiliary scintigraphy define the cause?

• Published in: Saudi journal of gastroenterology Vol. 18; no. 4; pp. 248 - 251
• Main Author: Othman, Saleh A
• Format: Journal Article
• Language: English
• Published: India Medknow Publications and Media Pvt. Ltd 01.07.2012; Medknow Publications & Media Pvt. Ltd; Medknow Publications & Media Pvt Ltd; Wolters Kluwer Medknow Publications
• Subjects: Abdominal pain; Abdominal Pain - diagnostic imaging; Abdominal Pain - etiology; Acalculous cholycystitis; Adult; Aged; Biliary tract diseases; Common Bile Duct Diseases - complications; Common Bile Duct Diseases - diagnostic imaging; Complications and side effects; Diagnosis; Female; Gallbladder Diseases - complications; Gallbladder Diseases - diagnostic imaging; hepatobiliary scintigraphy; hepatobiliary ultrasonography; Hospitals, University; Humans; Imino Acids; Liver; Male; Middle Aged; Oddi′s sphincter dyskinesia; Organotechnetium Compounds; Original; Pain; Predictive Value of Tests; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Retrospective Studies; Risk factors; RUQ abdominal pain; Sphincter of Oddi; Ultrasonic imaging; Ultrasonography; Ultrasound imaging; Saudi Arabia
• ISSN: 1319-3767; 1998-4049
• DOI: 10.4103/1319-3767.98429

The objective of this study was to assess the value of hepatobiliary scintigraphy (HS) for the diagnosis of right upper quadrant (RUQ) abdominal pain in patients with normal hepatobiliary ultrasound (HU). This is an observational study with a retrospective analysis of data from March 2008 to August 2010. We reviewed the HS results of 30 patients, aged 29-69 years (average 45.8 years); 12 male and 18 female patients. Patient selection to perform the HS was RUQ abdominal pain, suspected hepatobiliary disorder, and negative HU. All patients had gone through the standard procedure of HS. Based on predefined interpretation criteria, HS results were divided into 2 patterns: Normal (n=8, 25.8%) and abnormal (n=22, 73%): 18 patients (81.8%) having early gallbladder (GB) and common bile duct visualization, and delayed transit to small bowel (SB), which can be seen only after a fatty meal with normal or abnormal GB ejection fraction (GBEF) pattern characteristic of Oddi's sphincter dyskinesia. The remaining 4 patients (8.18%) had acalculous cholycystitis pattern: Delayed GB visualization with activity appearing in SB before GB. HS with fatty meal stimulation and GBEF estimation seems to be a reliable test, which may reveal a biliary cause in more than 70% of patients with RUQ abdominal pain and normal HU. Normal results exclude functional biliary cause. The decision for invasive or noninvasive therapeutic approach may depend on the results of HS.