Scintigraphic Findings in Acute Gangrenous Cholecystitis

False negative biliary scintigraphy in gangrenous cholecystitis

“…This will lead to a rim of increased activity in the inflamed area. The possibility of absence of the rim sign may reflect a gall bladder suspended by a mesentery and not in contact with the liver 7 . This entity may explain why in our patient there were no secondary signs of liver involvement as the pathology report suggested omentum was adhered to the gall bladder.…”

“…Shih et al 7 demonstrated three types of scintigraphic findings in patients with proven acute gangrenous cholecystitis. This included non‐visualization of the gall bladder, non‐visualisation of the gall bladder with a rim sign and non‐visualization of the gall bladder plus an enlarged photon deficient area corresponding to the gall bladder fossa.…”

The Use of Systemic Inflammatory Response Syndrome (SIRS) and Elevated Liver Enzymes as Predictive Factors of Gangrenous Cholecystitis: A Case Report

“…Additionally, an elevation of liver enzymes may signify the extension of the inflammatory process from the gallbladder wall to the liver causing hepatic parenchyma necrosis [17]. Lastly, a possible explanation of SIRS may be due to an increase in macrophage infiltration secondary to gangrenous changes leading to a release of proinflammatory cytokines and thus promoting the activation of the immune cascade in the absence of infection [18].…”

Sonography of gangrenous cholecystitis

“…Radio-nuclide biliary imaging with Technetium 99m di-isoimmino-diacetic acid (DISIDA) can be falsely negative in patients with gangrenous cholecystitis, although a “rim” sign surrounding the gall bladder from peri-hepatic uptake of isotope has also been reported in some patients. [1213]…”