Mirizzi Syndrome in a Cirrhotic Patient After TIPS Resolved by Technetium99m Mebrofenin Hepatobiliary Scan

Cholestatic pattern on the hepatic panel is common and can be caused by a broad array of etiologies. Although rare, with a prevalence as low as 0.06%, it is imperative to keep Mirizzi syndrome in the differential diagnosis when evaluating cholestasis. Due to the nonspecific presentation and inconsistent radiologic features, a high index of suspicion is needed to diagnose Mirizzi Syndrome. We present an unusual case of a 51-year-old man with worsening cholestatic laboratory tests and a normal ultrasound and abdominal computerized tomography. A technetium99m mebrofenin hepatobiliary acid scan suggested the diagnosis of Mirizzi syndrome that was later confirmed during an open cholecystectomy.