Isolated left hepatic lobe cholestasis demonstrated on cholescintigraphy

Cholescintigraphy was performed on a man of normal physique with a history of recurrent fever and moderately increased serum enzyme levels after biliary surgery. It revealed cholestasis in the entire left lobe of the liver that persisted 24 hours after injection, along with a small subhepatic biliary leak. The study was repeated 1 year later, when the patient had remained asymptomatic with normal results of biochemical tests for more than 6 months. Although the biliary leak had disappeared, nearly total left lobar cholestasis was again apparent for 24 hours. Ultrasound, computed tornography, and magnetic resonance imaging revealed no parenchymal abnormality, suggesting the absence of inflammatory liver disease. A developmental vascular anomaly allowing more of the tracer to flow to the left lobe or an anomaly of the intrahepatic biliary system limited to the left liver lobe are possible causes of these findings.