Hepatobiliary excretion of 99mTc-EC: A potential source of mistake in the interpretation of renal scintigraphy

A 10-year-old boy with a history of bloody discoloration of urine following recent appendectomy was referred to our department for urinary leakage/fistula evaluation. A renal Technetium-99m-L,L-ethylenedicysteine (99mTc-EC) scintigraphy was performed. After injection of radiotracer, a focus of activity appeared in the supralateral part of the right kidney which was confirmed as accumulation of radiotracer in the gall bladder by SPECT and delayed images. Although it is stated that the biliary excretion of 99mTc-EC is negligible, in some cases it could be prominent and potential source of misinterpretation.