Hepatobiliary Imino Diacetic Acid Scan in the Characterization of Spontaneous Bilomas

Case Report

Austin J Radiol. 2015;2(6): 1032.

Hepatobiliary Imino Diacetic Acid Scan in the Characterization of Spontaneous Bilomas

Sana S Khan*, Spencer Behr, Tianye Liu and Carina Mari Aparici

Department of Radiology and Biomedical Imaging, University of California, USA

*Corresponding author: Sana S Khan, Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry Street, Lobby 6 Suite 350, San Francisco, CA 94107-0946, USA

Received: May 05, 2015; Accepted: August 27, 2015; Published: August 28, 2015


A 64-year old man was presented to the emergency room for a lower extremity edema and cellulitis. Blood tests showed leukocytosis while computed tomography revealed multiple small hepatic fluid collections suspicious for abscesses. The patient developed sepsis after attempting to drain. Final diagnosis by Hepatobiliary Imino Diacetic Acid scan was spontaneous bilomas with iatrogenic septic complication, post-intervention.

Keywords: HIDA scan; Cholescintigraphy; Bilomas; Nuclear medicine


Intrahepatic bilomas usually occur after surgical procedures or trauma involving the biliary system [1]. However, there are reported cases of spontaneous bilomas in the literature, with the most suggested contributing factor being an intraductal pressure increase due to obstructive lesions or infarctions on the biliary tree [2]. Sonography and Computed Tomography (CT) are helpful first line noninvasive imaging techniques in identifying and localizing liver lesions. However, a large variety of hepatic fluid collections have overlapping characterization patterns [3]. A more specific diagnostic technique in the initial differential diagnosis is needed.

Case Report

We present the case of a 64-year old male with a history of diffuse Lymphodenopathy (LAD), elevated liver function tests and ampullary mass. An Endoscopic Retrograde Cholongiopacreatography (ERCP) showed atypical lymphoid hyperplasia suspicious for low-grade B cell lymphoma. However, repeat ampulla biopsies were benign. The patient also had an inguinal lymph node biopsy showing atypical T cell proliferation and B cell hyperplasia with negative T and B cell clonality studies.

Patient presented to the ER with lower extremity edema and redness concerning for cellulitis. The patient arrived afebrile with normal vital signs. However a blood test showed leukocytosis up to 17 x 109/L. CT revealed multiple hepatic small fluid collections concerning for abscesses. Interventional radiology drained one of the collections, finding pus-like fluid with a 4+ White Blood Count (WBC); however, no organisms ever grew from the fluid cultures.

Upon arrival to the ward, the patient reported chills and malaise. He was febrile to 39.4 °C, tachycardic to 120 bpm, and hypertensive up to 170 mm Hg systolic. The patient denied having nausea, vomiting, abdominal pain, diarrhea, constipation, dysuria, hematuria or abnormal discharge. The patient’s WBC was up to 58 x 109/L, meeting sepsis criteria. Blood and urine cultures were negative throughout patient’s hospitalization. Labs showed elevated alanine transminase, aspartate transminase, alkaline phosphatase, direct bilirubin and total bilirubin. Repeat CT reported non hyperenhancing numerous small liver masses and new perihepatic trace ascites. Comparison to a 5-year prior CT showed re-demonstration of the same liver fluid collections. Additional Magnetic Resonance Cholangiopancreaticgraphy (MRCP) was ordered, showing no biliary dilatation, stones, pancreatic mass or pancreatic duct dilation.

After consultation, Hepatobiliary felt cholangitis was unlikely, and imaging ruled out new biliary stricture or choledocholithiasis. MRCP was considered, but deferred due to the patient’s septic status. Interventional radiology was consulted for additional drainage, however, the masses were considered too small. A Hepatobiliary Imino Diacetic Acid (HIDA) scan was ordered, showing a patent common bile duct, normal gall bladder, decreased liver function, evidence of cholestasis and findings consistent with multiple intrahepatic bilomas. Infectious diseases diagnosed the patient with spontaneous bilomas and iatrogenic septic complication post-intervention. The patient recovered after intravenous treatment with antibiotics.

Citation: Khan SS, Behr S, Liu T and Aparici CM. Hepatobiliary Imino Diacetic Acid Scan in the Characterization of Spontaneous Bilomas. Austin J Radiol. 2015;2(6): 1032. ISSN :2473-0637