A biloma refers to an extrabiliary collection of bile. They can be either intra or extra hepatic.
They can result from a number of causes
- 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.
Although usually asymptomatic, they may present with symptomatic bile peritonitis.7
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
A Tc99 diisopropyl iminodiacetic acid (DISIDA) scan is useful for confirmation of an active bile leak.
Treatment options include
- pigtail drainage (under USG/CT guidance)
- surgical drainage
General imaging differential considerations include
- 1. Sakamoto I, Iwanaga S, Nagaoki K et-al. Intrahepatic biloma formation (bile duct necrosis) after transcatheter arterial chemoembolization. AJR Am J Roentgenol. 2003;181 (1): 79-87. AJR Am J Roentgenol (citation) - Pubmed citation
- 2. Shankar S, Vansonnenberg E, Silverman SG et-al. Diagnosis and treatment of intrahepatic biloma complicating radiofrequency ablation of hepatic metastases. AJR Am J Roentgenol. 2003;181 (2): 475-7. AJR Am J Roentgenol (citation) - Pubmed citation
- 3. Mueller PR, Ferrucci JT, Simeone JF et-al. Detection and drainage of bilomas: special considerations. AJR Am J Roentgenol. 1983;140 (4): 715-20. AJR Am J Roentgenol (citation) - Pubmed citation
- 4. Kwon HJ, Kim KW, Park JY et-al. Complications in living liver donors after partial liver procurement: an illustrative radiologic review. AJR Am J Roentgenol. 2007;189 (6): W338-43. doi:10.2214/AJR.07.2586 - Pubmed citation
- 5. Khalid TR, Casillas VJ, Montalvo BM et-al. Using MR cholangiopancreatography to evaluate iatrogenic bile duct injury. AJR Am J Roentgenol. 2001;177 (6): 1347-52. AJR Am J Roentgenol (citation) - Pubmed citation
- 6. Walker AT, Shapiro AW, Brooks DC et-al. Bile duct disruption and biloma after laparoscopic cholecystectomy: imaging evaluation. AJR Am J Roentgenol. 1992;158 (4): 785-9. AJR Am J Roentgenol (citation) - Pubmed citation
- 7. Haaga JR, Boll D. CT and MRI of the whole body. Mosby. (2009) ISBN:0323053750. Read it at Google Books - Find it at Amazon
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