Rim sign in Tc-99m sulfur colloid hepatic scintigraphy.
A case of pericholecystic hyperperfusion on Tc-99m sulfur colloid (SC) flow images with a pericholecystic rim of increased activity (PCHA) on delayed planar and single-photon emission computed tomography images of the liver was seen in a patient with a history of multiple renal transplants admitted with cramping right lower quadrant abdominal pain. Laparotomy performed 5 days after the scan revealed an acutely perforated gangrenous gallbladder and occluded cystic duct. The secondary findings of gallbladder hyperperfusion and PCHA or "rim sign" have been frequently reported with Tc-99m IDA hepatobiliary imaging. These secondary findings in conjunction with a nonvisualized gallbladder on an IDA scan suggest a complicated or advanced stage of acute cholecystitis and usually require urgent surgical intervention. The rim sign on Tc-99m SC scintigraphy also likely indicates the same grave diagnosis.
Joseph
Usha A
UA
Department of Radiology/Nuclear Medicine, University of Texas Houston Medical School, Houston, TX, USA. Usha.A.Joseph@uth.tmc.edu
Barron
Bruce J
BJ
Lamki
Lamk M
LM
D015746:Abdominal Pain / Q000175:diagnosis / Q000209:etiology; D041881:Cholecystitis, Acute / Q000000981:diagnostic imaging* / Q000209:etiology / Q000378:metabolism*; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects; D008099:Liver / Q000000981:diagnostic imaging* / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals / Q000493:pharmacokinetics; D013671:Technetium Tc 99m Sulfur Colloid / Q000493:pharmacokinetics*
D019275:Radiopharmaceuticals; D013671:Technetium Tc 99m Sulfur Colloid