DX: Biloma secondary to Gangrenous cholecystitis

Ok.This case was pretty laborious due to the fact that the clinician was depending on my appreciations to initiate theraphy. As I mentioned previously, US was very tedious because somehow patient did not cooperate and prominent kyphosis worsened the picture. CXR revealed some subphrenic air levels and elevated right hemidiaphragm, so clinician was suspecting hepatic abcess. Findings were a little misleading, did not agree with that impression but however I wasn't giving more options as well. CT scout revealed the same CXR impressions.

CT findings are remarkable and are consistent with pericholecystic fat stranding; enlarged, thick and irregular walls of gall bladder all of them pointing at Acute Cholecystitis without a doubt, but the most intriguing finding was a fluid collection lateral and adyacent to caudate lobe of the liver. It had dense liquid HU and was in the lesser sac. As one comment stated, could be secondary to pancreatitis but pancreas was spare.

What was it?..Ussually a complicated inflammatory process (probably a gangrenous state cholecystitis in this case?) develops fluid collection as an abcess. But in this case had no enhancing wall, relatively low peripheral inflammatory reaction and no air-fluid levels that are consistent with an abcess. So therefore fluid collection near or around biliary tree had to be a Biloma (had to be??..hehe).

Post-op note reported 100 cc of biliary fluid content (Biloma) and a gangrenous (perforated) gall bladder with active leakage.


Not the usual presentation of a biloma and literature only reported 1 case similar to mine. Here are the images:

This article by the AJR described this MRI images as a lamba-shaped fluid collection adyacent to caudate lobe representing a biloma. See the ressemblance to our case in the first image.

So remember, Bilomas are often seen following biliary tract surgery although they can also occur after trauma or erosion into the biliary tree from a malignant or inflammatory process.

Thank you for your time..comments are welcome!