Hemobilia refers to the presence of blood in the biliary tree.
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Clinical presentation
The classical Quincke triad, is seen with hemobilia in the context of hepatic arterial aneurysms, and consists of:
Pathology
Etiology
iatrogenic: surgical or percutaneous procedures (~67%)
-
trauma (~5%)
associated with pseudoaneurysm formation from central liver trauma
may manifest several (2-4) weeks after the initial injury
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vascular malformations (7%)
e.g. hepatic artery aneurysm or arteriovenous malformation
can cause massive hemobilia
malignancy (e.g. hepatocellular carcinoma - most common, gallbladder metastases)
abscess formation
gastrointestinal bleed due to gallstones
Radiographic features
Ultrasound
Ultrasound is often the first investigation and reveals echogenic material in the bile ducts and dilated gallbladder.
CT
high-attenuation clot within the bile ducts
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