False negative biliary scintigraphy in gangrenous cholecystitis

Gangrenous cholecystitis is a serious complication of acute cholecystitis and is associated with increased morbidity and mortality rates. We report a case in which the diagnosis was suggested by ultrasound, but cholecystectomy delayed due to atypical clinical presentation and a false negative radionuclide biliary scan. Radionuclide hepatobiliary imaging is a useful procedure for the diagnosis of acute cholecystitis. Visualization of the gall bladder essentially rules out acute cholecystitis, with 98% sensitivity. Therefore non-visualization suggests acute cholecystitis, but may also be associated with chronic gall bladder disease or other conditions. Copyright (2002) Blackwell Science Pty Ltd