Utilidad de la cintigrafía de vía biliar en el diagnóstico diferencial de colección intrahepática: l caso clínico / Usefulness of bile duct scintigraphy in the differential diagnosis of intrahepatic collection: a clinical case

Se presenta el caso clínico de un paciente de 48 años referido por cuadro clínico de dolor abdominal y omalgia derecha de 6 meses de evolución posterior a colecistectomía y resección hepatobiliar por Cancer vesicular. El TAC abdominal demostró una gran colección quística intrahepática. El AngioTAc no mostró comunicación vascular. Frente a la sospecha de un bilioma se efectuó cintigrafía de la vía biliar con Tc99m-DISIDA. Ésta demostró un gran defecto de captación intrahepático de límites netos que reemplazaba casi todo el lóbulo derecho, un lóbulo izquierdo de contraste normal y presencia de paso enlentecido del radiofármaco hacia intestino, hallazgos cintigráficos no sugerentes de un bilioma. Se efectuó una punción percutánea de la lesión bajo TAC la cual dió salida a contenido hemático oscuro. Inmediatamente después de efectuar una evacuación parcial se realizó un nuevo AngioTAC el cual confirmó sangramiento activo subcapsular en napa desde segmento VI del hígado como complicación tardía de colecistectomía.

An hepatobiliary scintigraphy with Tc-99m diisopropyl iminodiacetic acid (DISIDA) was done in a 48-year-old man who consulted for abdominal and right shoulder pain 6 months following hepatobiliary and gallbladder resection for a gallbladder cancer. The abdominal CT showed a huge intrahepatic cystic collection. The Angio-CT showed no vascular communication. Biliary scintigraphy with DISIDA showed a large cold intrahepatic defect in the right lobe not compatible with diagnosis of bilioma. The percutaneus punction revealed an haematic collection. After partial percutaneus evacuation done under CT, a new Angio-CT showed active subcapsular hepatic bledding from segment VI of the liver as a late complication of gallbladder surgery.

Cintigrafía de ventilación y perfusión en el manejo del tromboembolismo pulmonar / Ventilation and perfusion scintigraphy in patients with pulmonary thromboembolism

Background: The Progressive Investigation of Pulmonary Embolism Diagnosis (PIOPED) classifies the results of ventilation perfusion scintigraphy as having a high, intermediate and low diagnostic probability of pulmonary embolism or as normal. This classification can be confusing for the clinician. Aim: To retrospectively review the diagnoses of ventilation perfusion scintigraphies performed at a general hospital. Material and methods: All reports of ventilation perfusion scintigraphies done between 1997 and 2000 at the Nuclear Medicine Service of Valdivia Hospital were retrospectively reviewed. Results: During the study period, 85 patients with suspected pulmonary thromboembolism were referred for a ventilation perfusion scintigraphy and in 70, the procedure was done. Twenty-one (30 percent) patients were classified as having a high probability of pulmonary thromboembolism, 12 (17 percent) as having an intermediate probability, 31 (44 percent) as having a low probability and the scintigraphy was considered normal in 6 (9 percent) patients. Conclusions: The predictive value of ventilation perfusion scintigraphy must be interpreted using this diagnostic classification