Normal cholescintigram in In-111 WBC positive acute acalculous cholecystitis. The converse photopenic 'rim' sign

Area of Science:

• Gastroenterology
• Nuclear Medicine
• Pathology

Background:

• Acute acalculous cholecystitis (AAC) is inflammation of the gallbladder without gallstones.
• AAC can present atypically, posing diagnostic challenges.

Observation:

• A patient with AAC presented with a negative cholescintigram.
• The cholescintigram revealed a distinctive pericholecystic photopenic halo.

Findings:

• An Indium-111 white blood cell (In-111 WBC) scan confirmed the diagnosis of AAC.
• Histopathological examination provided definitive diagnostic confirmation.

Implications:

• The findings suggest that a pericholecystic photopenic halo on cholescintigraphy may indicate AAC.
• In-111 WBC scans can be valuable in diagnosing AAC when conventional imaging is inconclusive.
• This case underscores the importance of integrating multiple diagnostic modalities for complex cases.