Detection of bile leakage into the thoracic cavity by hepatobiliary scintigraphy

Abstract

We report early detection of bile leakage into the thoracic cavity by hepatobiliary scintigraphy in a rare case of spontaneous withdrawal of the catheter for percutaneous transhepatic cholangiographic drainage (PTCD). An 81-year-old man with inoperable carcinoma of the common bile duct was readmitted with a 38 degrees C fever and suspected bile leakage from the hepatic biliary tree following withdrawal of the catheter for PTCD. While plain X-ray immediately after readmission revealed no abnormality in the chest or abdomen, hepatobiliary scintigraphy revealed not only bile leakage into the right thoracic cavity but also the site of laceration. We conclude that hepatobiliary scintigraphy is a simple, non-invasive procedure useful in the early detection and localization of bile leakage following spontaneous withdrawal of the catheter for PTCD.

It is a bile!

“…16 Although lung injury can be easily avoided during PTBD with the use of ultrasonography or CT together with estimation of the extent of the pleural space prior to the procedure, 17 the PTBD catheter may be mis-inserted through the pleural space as the liver is anatomically surrounded by the thoracic cavity. 18,19 Also, bile leakage along the drain has been reported after PTBD as a late complication in 18.8%-21.7% of patients. 20 Bile is a strong inflammatory stimulus due to both a direct corrosive effect on the pleural layers and also a very good soil for bacterial infection with empyema formation causing a therapeutic challenge for the clinicians.…”

Bilothorax as a complication of percutaneous transhepatic biliary drainage

“…However, because the pleural space is usually difficult to detect by ultrasonography if there is no pleural effusion, the PTBD catheter might be inserted through the pleural space. 5 When a biliary pleural fistula occurs as a result of PTBD, bile leakage into the pleural space develops easily due to the negative pressure in the pleural space. Bile leakage along the drain has been reported as a late complication after PTBD in 18.8%–21.7% of patients.…”

Bile leakage after laparoscopic cholecystectomy demonstrated with99mTc-PMT hepatobiliary scintigraphy

“…12 Among them, hepatobiliary scintigraphy has proven a valuable procedure as it provides a sensitive noninvasive assessment of bile leakage, ductal obstruction and complications. [6][7][8][9] Weissmann et al 13 reported that ssmTc -IDA imaging is a simple, noninvasive way to detect the presence of a bile leak following cholecystectomy. Pasmans et als reported the role of ssmTc-HIDA cholescintigraphy in diagnosing bile leakage after laparoscopic cholecystectomy.…”

“…6 Hepatobiliary scintigraphy is a noninvasive method for examining the bile ducts and looking for bile leakage. [6][7][8][9] 99m Tc-Sn-N-pyridoxyl-5-methyltryptophan (99mTc-PMT) has more rapid blood clearance and hepatobiliary transit than any other hepatobiliary agent. 10 Less 99 mTc-PMT than 99 mTc-DEIDA is less excreted in the urine, and 99 mTc-PMT is superior in that biliary excretion of the radioactivity is less likely to be suppressed in hyperbilirubinemia.…”