HEPATOBILIARY EXCRETION OF MAG3 - SIMULATION OF A URINARY LEAK

A Tc-99m MAG3 renal scintigram was performed on a patient with severe renal insufficiency and bilateral ureteral stents. The Tc-99m MAG3 stu dy displayed typical findings for renal insufficiency but also suggest ed the presence of lower tract obstruction. Moreover, the delayed post erior and posterior oblique views of the abdomen revealed an extrarena l collection of tracer suggestive of a urinary leak. With the help of additional views, this extrarenal activity was proven to be tracer in the bowel and biliary system. Biliary excretion of Tc-99m MAG3 can be prominent in patients with renal insufficiency and could lead to an er roneous diagnosis of urinary leak. Finally, scintigraphic diagnosis of lower tract obstruction may be difficult in patients with renal insuf ficiency, but some helpful signs may lead to the correct diagnosis.