Pseudo-splenic uptake in a DISIDA scan. A normal liver variant

An 85-year-old man was admitted with right upper quadrant pain, jaundice, fever, and elevated liver function tests. As part of his work-up a Tc-99m disofenin scan was obtained revealing nonvisualization of the gallbladder, delayed excretion into the bowel at two hours, and an unusual anatomical variant of the left lobe of the liver simulating splenic uptake. Anatomical variants may sometimes represent diagnostic problems on imaging and their importance should therefore be recognized. In this case, due to the presence of partial common bile duct obstruction and delayed bowel visualization, the early images pointed to the possibility of unexplained splenic uptake or the inadvertent use of Tc-99m sulfur colloid instead of Tc-99m disofenin.