Use of hepatobiliary scintigraphy to diagnose bile duct atresia in a lamb

A neonatal lamb was admitted with icterus, hypoglycemia, increased liver enzyme activities, and delayed sulfobromophthalein clearance. Biliary and pancreatic duct atresia were documented in this lamb at necropsy. Hepatobiliary scintigraphy was useful in reaching an antemortem diagnosis of bile duct obstruction. Hepatobiliary scintigraphy, using 1.5 mCi of 99m technetium-labeled acid, was performed on the affected lamb and on an age-matched control lamb. Using a large field-of-view camera equipped with a low-energy parallel-hole collimator, right ventral oblique images of the thorax and abdomen were obtained. Images were simultaneously recorded on microdot film by use of a dedicated nuclear medicine computer. In the control lamb, there was rapid clearance of radioactivity from the blood pool, coincident with obvious accumulation of radioactivity in the liver and followed by sequential accumulation in the intrahepatic biliary system, gallbladder, common bile duct, and small intestine. Results of the study in the affected lamb were characterized by prolonged blood-pool radioactivity without appreciable hepatic uptake and by excessive renal and urinary bladder activity in the later phases of the study. Hepatobiliary scintigraphy was a safe and non-invasive procedure that provided quantitative information about the degree of bile duct obstruction in the affected lamb.