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Biloma

A biloma refers to an extrabiliary collection of bile. They can be either intra or extra hepatic. 

Pathology

They can result from a number of causes

  • spontaneous 
  • post traumatic
  • post instrumentation
    • transcatheter arterial chemoembolization (TACE)
    • percutaneous ethanol injection
    • microwave ablation
    • percutaneous biliary drainage
    • post surgical : e.g injury to duct of Luschka following cholecystectomy 6

Seventy percent of bilomas are localized to the right upper quadrant, whereas the remaining 30% develop in the left upper quadrant. A biloma may wall off or may continue to demonstrate active bile leakage.

Clinical presentation

Although usually asymptomatic, they may  present with symptomatic bile peritonitis.7

Radiographic features

CT & MRI

On CT and MRI,  bilious fluid demonstrates water attenuation,  variable signal  intensity on T1-weighted imaging, and high signal intensity on T2-weighted imaging, similar to the signal intensity of gallbladder fluid.

Both gadolinium and manganese-based MRI contrast agents that  are excreted through the biliary system are available. A delayed enhanced MRI examination using one of these agents may be useful to confirm that a localized fluid collection is composed of bile and to identify the site of bile leak.7

Scintigraphy

A Tc99 diisopropyl iminodiacetic acid (DISIDA) scan is useful for confirmation of an active bile leak.

Treatment

Treatment options include

  • pigtail drainage (under USG/CT guidance)
  • surgical drainage

Differential diagnosis

General imaging differential considerations include

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