Hepatobiliary scintigraphy evaluates the biliary clearance of Tc-99m-labeled iminodiacetic acid agents (Tc-99m IDA) and has a high sensitivity and specificity for the diagnosis of acute cholecystitis. False-negative studies are extremely rare. We describe an apparently normal nonmorphine-augmented hepatobiliary study in gangrenous acalculous cholecystitis. Based on clinical findings, computed tomography, and ultrasound demonstration of a dilated gallbladder, a cholecystectomy was performed. Pathologic examination of the gallbladder revealed acute gangrenous cholecystitis with culture positive for Klebsiella pneumoniae.
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