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

Pathology

They can result from a number of causes:

  • spontaneous 
  • posttraumatic
  • postinstrumentation
    • 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 localised 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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