PMC3881441_01
Ultrasonography scan of liver showing multilocular anechoic cystic lesion made up of multiple cysts that ranged from 10 to 45 mm in diameter occupying whole left hepatic lobe. Biliary and vascular structures are displaced but not involved.
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Patient underwent ultrasonography of the abdomen that revealed a septated cystic lesion with "honeycomb-like" structures localized in the hepatic left lobe (Figure 1).
Abdominal computed tomography scan obtained after administration of contrast material shows mild biliary tree dilatation and a fluid collection with some air bubbles within.
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A computed tomography study of the abdomen revealed a mild bile duct dilatation and an inhomogeneous collection with air bubbles in the area where previous surgical treatment was made (Figure 2).
(a), (b) Axial fat saturated T2-weighted magnetic resonance images showing bile ducts dilatation and a fluid collection around left hepatic lobe and around gallbladder; inside the main bile duct and in the gallbladder note materials with hypointense signal due to blood clots. (c), (d) 2D and 3D haste MIP images showing low signal intensity of blood clots inside dilatated bile tree, sign of haemobilia, and inflammatory narrowing of distal choledocus.
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On magnetic resonance images there was material into bile ducts with mixed signal intensity on T2-weighted images according to the presence of blood products in various stages of breakdown (Figure 3).
Endoscopic retrograde cholangiopancreatography. After endoscopic maior papillary sphincterotomy and drainage of blood clots mixed up with bile, cholangiography with iodinated contrast media retrograde injection shows mild bile ducts dilatation.
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Our patient underwent a therapeutic endoscopic retrograde cholangiopancreatography procedure that confirmed hepatobiliary tract dilatation because of obstruction by blood clots (Figure 4).