usmlebuzz
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A 72-year-old diabetic woman presented to the emergency room with colicky right upper quadrant (RUQ) pain and vomiting. She had a low-grade fever and moderate RUQ tenderness on physical examination. Laboratory evaluation was remarkable with a white blood count (WBC) of 14 K/ml.
Abdominal ultrasound demonstrates echogenic sludge within a moderately distended gallbladder. No discrete gallstone is visible. The gallbladder wall is not thickened . There is no biliary ductal dilatation.
Serial images from a Tc-99m-IDA scan show normal hepatic uptake of radiotracer with normal visualization of common duct and bowel at 30 minutes after injection. The gallbladder is not visualized at 1 hour despite an intravenously administered dose of morphine sulfate
what is the diagnosis?
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| meg
Forum Guru
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Acute cholecystitis
delayed images should be obtained at 3 to 4 hours and/or 24 hours post-injection.
Morphine sulfate helps to differentiate acute from chronic cholecystitis and decreases the time needed to make a clinical diagnosis. Morphine acts by constricting or "clamping down" the sphincter of Oddi (also known as the sphincter of the hepatopancreatic ampulla) causing increased pressure in the common bile duct which forces the radiotracer into a patent cystic duct and hence the gallbladder
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| usmlebuzz
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correct 
great answer
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| mjl1717
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No offense but this would match better in the pathology forum :shock:
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| usmlebuzz
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I wanted to place this in surgery forum but dont know how it ended up here :icon_scratch:
sorry for the inconvenience
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