hemobilia

Hemobilia refers to the presence of blood in the biliary tree.

Clinical presentation

The classical clinical triad, only seen in ~50% of cases, 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
• 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

Siehe auch:

• percutaneous transhepatic cholangiography (PTC)
• arterio-portal fistula

und weiter:

• transjuguläre Leberbiopsie
• pseudoaneurysm of the hepatic artery with associated arterio-portal fistula and hemobilia