Gallbladder bed photopenic halo on hepatobiliary scintigraphy: A sign of biliary leakage

A 34-year-old woman who had received a kidney transplant underwent Tc- 99m mebrofenin hepatobiliary scintigraphy to evaluate suspected biliary leakage several days after laparoscopic cholecystectomy for chronic symptomatic cholelithiasis. The study showed an unusual circumferential photopenic rim around the gallbladder bed on hepatobiliary scintigraphy that preceded obvious scan evidence of biliary leakage. Severe inflammatory changes in the soft tissues around the gallbladder with local fluid collections are likely to be associated with this 'reverse halo sign.' This photopenic halo sign is different from the well-known 'rim' sign that is often seen in acute gangrenous cholecystitis.