Bilomas refer to extrabiliary collections of bile. They can be either intra- or extrahepatic.
They can result from a number of causes:
- 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.
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
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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