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December Case of the Month


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Authors: Joshua F. Smith, MD, PGY-3, Resident, Radiology, Department of Radiology and Medical Imaging, and Luke Lancaster, MD, Associate Professor, Nuclear Medicine and Pediatric Radiology, Department of Radiology and Medical Imaging

Institution: University of Virginia

Why did you select this case for submission?

This case shows the continued value of planar nuclear medicine studies in an era when more complex imaging modalities get more attention.

What should readers learn from this case?

This case should serve as a review of several common diagnoses that can be made from a nuclear medicine hepatobiliary (HIDA) scan. It serves as a reminder not to jump straight to a diagnosis of acute or chronic cholecystitis when the gallbladder is not visualized, but to consider all of the findings present.

What did you learn from working on the case?

This case reminded us to think through the physiology behind tracer excretion of the HIDA tracer when considering the possible etiologies of right upper quadrant pain, and again not to not immediately jump to diagnosing cholecystitis when delayed images do not show gallbladder uptake.

How did guidance from senior staff at your institution impact your learning and case development?

Dr. Lancaster, a nuclear medicine and pediatric radiologist at the University of Virginia, was an enormous resource for the teaching points and design of this case. He is committed to educating residents and helped make this project fun and informative.

Why did you choose Case in Point for submission of your case?

The format is a great resource for education, with cases taking a relatively short amount of time to convey numerous practical teaching points. This seemed like a perfect fit for this case.

What is the appeal of online learning tools such as Case in Point as opposed to print learning venues?

Online learning remains flexible and up-to-date. It is the new norm and is much more interactive, enabling the learning experience to become more active, maximizing both memory of the material and critical thinking.

Are you a regular reader of Case in Point? What are your favorite types of cases?

Yes, I am a regular reader of Case in Point, and I most enjoy cases that I can incorporate into my own day-to-day work and those that help me when I am on call.

What else should we know about the case that you'd like to share?

This case is a reminder that nuclear medicine techniques primarily image physiology rather than anatomy. Despite the fact that nuclear medicine planar images often are not detailed or visually appealing, there is often a large amount of information available from the images, when the physiology behind them is considered.

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