PMC3179881_01
Preoperative abdominal CT. Massive liver hydatid cyst replacing segments IV to VIII.
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fig1
A 72-year-old woman with abdominal complaints for several months was found to have a large right upper quadrant cystic mass (16 x 17 x 18 cm), consistent with a multivesicular liver hydatid cyst that replaced the right lobe of the liver, with compensatory hypertrophy of the left lateral segment (LLS) (Figure 1).
ERCP showing a stop at the level of the biliary confluence and a contrast leak.
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fig2
ERCP showed an obstruction at the level of the biliary confluence and a contrast leak (Figure 2).
99mTc Mebrofenin scintigraphy: a fistulous tract is seen connecting the liver and the lower right lobe (arrow). A gauze with the patient sputum had enough radioisotopes to be detected by the gamma camera (right, bottom). ANT: anterior view.
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fig3
Amersham Health, Gipharma, Saluggia, Italy) which confirmed the diagnosis of biliobronchial fistula (BBF). A fistulous tract connected the liver and the right lower lobe; the patient's sputum contained enough radioisotopes to be detected by the gamma camera (Figure 3).
Percutaneous transhepatic cholangiography. Bile duct dilation is seen, with a biliothoracic leak (BBF).
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fig4
Given the postsurgical anatomy, the patient underwent percutaneous transhepatic cholangiography which was notable for bile duct dilatation, stenosis of the biliojejunal anastomosis, and biliothoracic leak (BBF) (Figure 4).