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Biloma

Dr MT Niknejad and Dr Yuranga Weerakkody et al.

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

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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