MyPACS.net: Radiology Teaching Files > Case 1507269

never visited BILOMA
Contributed by: Meghann Prusick, Triton College, Illinois, USA.
Patient: 55 year old male
History: An ultrasound is requested on a 55 year old male post liver transplant to evaluate the hepatic artery flow. In a previous ultrasound performed the hepatic artery was not patent. The patient presented with no pertinent symptoms.
Images:[small]larger

Fig. 1: Long image of the subscapular fluid mass.

Fig. 2: Image shows a large amount of debris within the fluid.

Fig. 3: Color is added to show there is no flow within the mass.
Findings: Upon examination, it was noted that the liver appeared slightly hyperechoic. A moderate right pleural effusion was present as well as a small amount of ascites that contained low level echoes in the right lower quadrant. On a color Doppler study, the portal vein, hepatic artery, and hepatic veins had flow in the normal direction. In addition, an oval shaped, almost anechoic fluid collection measuring 3 x 1 x 1.5 cm was visualized in the right lobe of the liver.
Diagnosis: Findings suggested that the subscapular fluid collection seen in the right lobe of the liver is consistant with a biloma.
Discussion:

A biloma is an encapsulated collection of bile in the peritoneal cavity. They can result from a bile duct disruption or some sort of hepatic trauma.
Ultrasound examination will usually reveal a well-defined fluid collection within the liver. Low level echoes may be present due to hemmorrhage or debris contained within.
A differential diagnosis for a biloma could be a liver cyst and differentiation can be made by needle aspiration.
The majority of bilomas will resolve spontaneously, however, they may require drainage if they enlarge or show signs of infection.

References:

Amersham Health "Biloma". Online. 03 March 2005. http://www.amershamhealth.com/medcyclopedia/volume%201v%201/BILOMA.ASP

Medical Dictionary "Definitions of Popular Terms". Online. 03 March 2005
http://www.medterms.com/script/main/art.asp?articlekey=39743

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Additional Details:

Case Number: 1507269Last Updated: 04-27-2005
Anatomy: Other   Pathology: Trauma
Modality: USExam Date: 03-07-2005Access Level: Readable by all users

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