Computed tomography and ultrasonographic correlation of intrahepatic biloma in an immuno-compromised patient- An incidental finding: A case study

Abstract

The term biloma is used to describe an encapsulated collection of bile within the abdomen, or around the liver and is usually a result of bile duct disruption. The formation of bilomas usually follows abdominal trauma, laparascopic intervention within the hepatobiliary system or pancreatic cancer. The correct diagnosis of a likely biloma is important as several other pathologies may give similar clinical or laboratory presentation. Patient may show clinical features of pain in the right upper quadrant, abdominal distension, malaise, anorexia, nausea, chills and fever. Diagnostic imaging work-up may include Abdominal ultrasound, CT scan, Magnetic Resonance cholangio-pancreatography (MRCP) and occasionally gallbladder scintigraphy. Generally, the presence of atraumatic biloma in an immune-compromised patient is somewhat uncommon in literature. We present a case of intrahepatic biloma in a 63 year old hypertensive male, with immune-compromise with no recent or past history of trauma or laparascopic abdominal procedure. The sonographic appearance is that of a single or multi-loculated anechoic lesions with visible distal acoustic enhancement, with or without internal echoes/debris. Occasionally, there may be few stations, but a well-defined capsule is usually absent. Bilomas of long-standing origin may develop thicker margins and this may become confusing. Our patient presented with this classical ultrasound features of an anechoic lesion, with through transmission and also communicates with the biliary system. Diagnostic accuracy is enhanced by a correlation of clinical findings and recent history with ultrasonographic findings.The clinical, laboratory as well as sonographic and computed tomographic (CT) correlations are presented.

Keywords: Biloma, immune-compromised, atraumatic, laparacopy, hepatobiliary system