EURORAD ESR

Case 9483

Iatrogenic bile duct injury following cholecystectomy: multimodal imaging diagnosis and classification

Author(s)
Tonolini, Massimo
Department of Radiology, “Luigi Sacco" University Hospital – Milan (Italy)

Email:mtonolini@sirm.org
 
Patient
male, 39 year(s)
 
 
  • Figure 1
    Postoperative MR Cholangiopancreatography (MRCP)
     

    Coronal (a) and axial (b) T2-weighted images show a 6x4 cm ovoid collection in the gallbladder fossa, reached by the drainage tube (arrowhead in b).

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: MR; Procedure: Cholangiography; Special Focus: Obstruction / Occlusion;

    Coronal (a) and axial (b) T2-weighted images show a 6x4 cm ovoid collection in the gallbladder fossa, reached by the drainage tube (arrowhead in b).

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: MR; Procedure: Cholangiography; Special Focus: Obstruction / Occlusion;

    Thick-slab (c) and MIP reformations form coronal thin-section (d,e) MRCP images visualize moderate dilatation of intrahepatic ducts and common hepatic duct, with abrupt termination; normal-caliber choledochus.

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: MR; Procedure: Cholangiography; Special Focus: Obstruction / Occlusion;

    Thick-slab (c) and MIP reformations form coronal thin-section (d,e) MRCP images visualize moderate dilatation of intrahepatic ducts and common hepatic duct, with abrupt termination; normal-caliber choledochus.

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: MR; Procedure: Cholangiography; Special Focus: Obstruction / Occlusion;

    Thick-slab (c) and MIP reformations form coronal thin-section (d,e) MRCP images visualize moderate dilatation of intrahepatic ducts and common hepatic duct, with abrupt termination; normal-caliber choledochus.

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: MR; Procedure: Cholangiography; Special Focus: Obstruction / Occlusion;
     
     
  • Figure 2
    Postoperative contrast-enhanced MDCT acquisition
     

    Axial contrast-enhanced (a) and thick-slab MinIP reformation (b) confirm moderate intrahepatic ductal dilatation.

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: CT; Procedure: Cholangiography; Special Focus: Obstruction / Occlusion;

    Axial contrast-enhanced (a) and thick-slab MinIP reformation (b) confirm moderate intrahepatic ductal dilatation.

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: CT; Procedure: Cholangiography; Special Focus: Obstruction / Occlusion;

    Axial unenhanced (c) and post-contrast (d) images confirm a sizeable, inhomogeneous postoperative collection in the gallbaldder fossa.

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: CT; Procedure: Cholangiography; Special Focus: Obstruction / Occlusion;

    Axial unenhanced (c) and post-contrast (d) images confirm a sizeable, inhomogeneous postoperative collection in the gallbaldder fossa.

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: CT; Procedure: Cholangiography; Special Focus: Obstruction / Occlusion;

    Coronal thick-slab MIP image depicts multiple metallic clips from recent cholecystectomy and gallbladder fossa haemostasis.

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: CT; Procedure: Cholangiography; Special Focus: Obstruction / Occlusion;

    Oblique-coronal reformatted images (f,g) depict dilated intrahepatic branches and common hepatic duct stump, just above metallic clips.

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: CT; Procedure: Cholangiography; Special Focus: Obstruction / Occlusion;

    Oblique-coronal reformatted images (f,g) depict dilated intrahepatic branches and common hepatic duct stump, just above metallic clips.

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: CT; Procedure: Cholangiography; Special Focus: Obstruction / Occlusion;
     
     
  • Figure 3
    Postoperative Endoscopic Retrograde CholangioPancreatography (ERCP)

    Contrast medium retrogradely injection during ERCP opacifies common bile duct up to surgical clips, indicating tight stenosis.

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: Plain radiographic studies; Procedure: Cholangiography;
     
     
Coronal (a) and axial (b) T2-weighted images show a 6x4 cm ovoid collection in the gallbladder fossa, reached by the drainage tube (arrowhead in b).
 
Coronal (a) and axial (b) T2-weighted images show a 6x4 cm ovoid collection in the gallbladder fossa, reached by the drainage tube (arrowhead in b).
 
Thick-slab (c) and MIP reformations form coronal thin-section (d,e) MRCP images visualize moderate dilatation of intrahepatic ducts and common hepatic duct, with abrupt termination; normal-caliber choledochus.
 
Thick-slab (c) and MIP reformations form coronal thin-section (d,e) MRCP images visualize moderate dilatation of intrahepatic ducts and common hepatic duct, with abrupt termination; normal-caliber choledochus.
 
Thick-slab (c) and MIP reformations form coronal thin-section (d,e) MRCP images visualize moderate dilatation of intrahepatic ducts and common hepatic duct, with abrupt termination; normal-caliber choledochus.
 
Axial contrast-enhanced (a) and thick-slab MinIP reformation (b) confirm moderate intrahepatic ductal dilatation.
 
Axial contrast-enhanced (a) and thick-slab MinIP reformation (b) confirm moderate intrahepatic ductal dilatation.
 
Axial unenhanced (c) and post-contrast (d) images confirm a sizeable, inhomogeneous postoperative collection in the gallbaldder fossa.
 
Axial unenhanced (c) and post-contrast (d) images confirm a sizeable, inhomogeneous postoperative collection in the gallbaldder fossa.
 
Coronal thick-slab MIP image depicts multiple metallic clips from recent cholecystectomy and gallbladder fossa haemostasis.
 
Oblique-coronal reformatted images (f,g) depict dilated intrahepatic branches and common hepatic duct stump, just above metallic clips.
 
Oblique-coronal reformatted images (f,g) depict dilated intrahepatic branches and common hepatic duct stump, just above metallic clips.
 
Contrast medium retrogradely injection during ERCP opacifies common bile duct up to surgical clips, indicating tight stenosis.
 
 
 
Home Search Sections Teaching Cases History FAQ Case Archives Contact Login Disclaimer Imprint Switch to MOBILE version
View desktop version