PMC4152250_01
US image (A) demonstrates hyperechogenic, irregular structures in the lumen of the gallbladder (marked between cursors) as well as gallbladder wall thickening (B) to approximatly 0.5 cm.
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However, there were some abnormalities within the gallbladder, which was 30% larger than at the initial examination (Figure 1) - examinations were performed in fasted condition.
A) In the late venous phase, the portal vein with intrahepatic flow is seen. Significant extravasation of the contrast agent from the middle portion of the right hepatic artery to one of the branches of the portal vein was found. During the examination the presence of contrast agent in the biliary ducts was observed which confirmed the existence of the arterio-biliary fistula with characteristic peripheral wedge-shaped hepatic parenchymal enhancement. (B) Coronal CT C + MPR reconstruction visualizes transient hepatic parenchymal enhancement (THPE). Triangular hyperattenuating area in hepatic arterial phase (segments VI and VII) with normal appearance of the rest of the liver in the portal phase. The presence of blood/haematoma in the gallbladder was confirmed (arrow).
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It revealed liver enlargement, vascular disorders in the 5th and 6th segment and the presence of a haematoma in the gallbladder (Figure 2).
In the middle part of the right hepatic artery, significant extravasations (E) of the contrast agent (with the fistula to one of the branches of the portal vein) were visualised. Note the tortuosity of the common hepatic (*) and splenic (#) arteries. The left gastric artery (g) has a normal appearance.
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The boy was transferred to the Infectious Diseases Department for further specialist treatment after four days (Figures 3 and 4).
Follow-up arteriography demonstrated a complete occlusion of the damaged branch of the hepatic artery and no blood flow through the fistula.
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The boy was transferred to the Infectious Diseases Department for further specialist treatment after four days (Figures 3 and 4).