CT - CT liver
Axial C+ arterial phase
C+ portal venous phase
Coronal C+ portal venous phase
Sagittal C+ portal venous phase
Performed a result of abnormal intrahepatic arteries, and the unusual gas in the right lobe at the ultrasound.
Arterial phase: the aortic conduit is occluded approximately 2cm from its origin. There is very little, if any contrast opacification of the intrahepatic arteries. (There may be some collateralisation via the GDA). There is pneumobilia and a gas-containing collection in the right lobe of the liver.
Portal venous phase: There is heterogeneous enhancement of the graft with peripheral wedge-shaped low attenuation adjacent to the gas-containing collection in the right lobe. This collection is connected to the biliary tree via the right posterior sectoral duct which is abnormally dilated and contains the same material as the collection. The portal vein is patent. There is periportal oedema. Bilateral atrophic kidneys with cysts - a sign of chronic renal failure - and a partially imaged unremarkable renal graft in the right iliac fossa are incidentally noted.
Overall findings are in keeping with biliary necrosis and abscess formation, secondary to hepatic artery compromise due to anastomotic stenosis and subsequent occlusion of the aortic conduit.