title: Biliary imaging: multimodality approach to imaging of biliary injuries and their complications.
abstract: Although traumatic and iatrogenic bile leaks are rare, they have become more prevalent in recent years due to an increased propensity toward nonsurgical management of patients with liver trauma and an overall increase in the number of hepatobiliary surgeries being performed. Because clinical signs and symptoms of bile leaks are nonspecific and delay in the recognition of bile leaks is associated with high morbidity and mortality rates, imaging is crucial for establishing an early diagnosis and guiding the treatment algorithm. At computed tomography or ultrasonography, free or contained peri- or intrahepatic low-attenuation (low-density) fluid in the setting of recent trauma or hepatobiliary surgery should raise suspicion for a bile leak. Hepatobiliary scintigraphy and magnetic resonance (MR) cholangiopancreatography with hepatobiliary contrast agents can help detect active or contained bile leaks. MR cholangiopancreatography with hepatobiliary contrast agents has the added advantage of being able to help localize the bile leak, which in turn can help determine if endoscopic management is sufficient or if surgical management is warranted. Endoscopic retrograde cholangiopancreatography may provide diagnostic confirmation and concurrent therapy when nonsurgical management is pursued. A multimodality imaging approach is helpful in diagnosing traumatic or iatrogenic biliary injuries, accurately localizing a bile leak, and determining appropriate treatment.
authors.affiliation: From the Department of Radiology, Boston University Medical Center, 820 Harrison Ave, 3rd Floor, Boston, MA 02118.
authors.forename: Kira
authors.initials: K
authors.lastname: Melamud
authors.forename: Christina A
authors.initials: CA
authors.lastname: LeBedis
authors.forename: Stephan W
authors.initials: SW
authors.lastname: Anderson
authors.forename: Jorge A
authors.initials: JA
authors.lastname: Soto
mesh_terms: D000007:Abdominal Injuries / Q000150:complications / Q000175:diagnosis; D001646:Bile; D001659:Biliary Tract / Q000000981:diagnostic imaging / Q000293:injuries*; D049448:Cholangiopancreatography, Magnetic Resonance / Q000379:methods; D003287:Contrast Media; D003952:Diagnostic Imaging / Q000379:methods; D006801:Humans; D007431:Intraoperative Complications / Q000175:diagnosis; D008099:Liver / Q000293:injuries; D064847:Multimodal Imaging / Q000379:methods*; D011859:Radiography; D014463:Ultrasonography; D014949:Wounds, Nonpenetrating; D014950:Wounds, Penetrating
chemical_list: D003287:Contrast Media