HEPATOBILIARY SCINTIGRAPHY IN A PATIENT WITH BILHEMIA

A 4-year-old child referred for acute jaundice following percutaneous needle biopsy of the liver hepatobiliary scintigraphy. Although all li ver tests suggested preservation of hepatocyte function, the tracer up take in the liver appeared dramatically reduced at scintigraphy and th e blood pool activity did not decrease significantly until the end of the study. Visualization of the bile ducts indicated, however, that th e tracer was taken up by the hepatocyte and further excreted into the biliary tree. There was no tracer pooling in the biliary tree although no bowel activity was observed, even on delayed images. The associati on of persistent blood pool activity, bile duct visualization without tracer pooling, and nonvisualization of the bowel was caused by a cont inuous recirculation of the tracer from the biliary tree into the bloo dstream. The presence of a biliovenous fistula was further proven by p ercutaneous transhepatic cholangiography performed 24 h later. Since 1 975, only 16 cases of bilhemia have been reported. To the best of our knowledge the scintigraphic pattern of this rare but life-threatening complication has not previously been reported.