Atypical Primary Sclerosing Cholangitis Findings on a 99mTc-Mebrofenin Scan

We present an 80-year-old woman with cholestatic liver disease. Ultrasound, CT, and MR cholangiopancreatography showed no substantial findings. The patient was referred for a hepatobiliary scan to examine the physiological pathway of bilirubin and to determine for any level of obstruction. The findings on the hepatobiliary scan suggested intrinsic pathology affecting the entire biliary tree, and histology was recommended. Histology confirmed primary sclerosing cholangitis (PSC). Although hepatobiliary scintigraphy in biliary stasis is well-known and well-published, hepatobiliary scintigraphy in PSC in adults is not well-documented. The hepatobiliary scintigraphy provided the primary and definitive imaging technique in directing the management and diagnosis of PSC in our patient.