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Bilomas refer to extrabiliary collections of bile. They can be either intra- or extrahepatic. 


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


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


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

Differential diagnosis

General imaging differential considerations include:

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