Intrahepatic Biloma Formation (Bile Duct Necrosis) After Transcatheter Arterial Chemoembolization
Ichiro Sakamoto1,
Soji Iwanaga2,
Kenji Nagaoki1,
Yojiro Matsuoka3,
Kazuto Ashizawa1,
Masataka Uetani1,
Toshio Fukuda4,
Tomoaki Okimoto1,
Sadayuki Okudaira5,
Katsuhisa Omagari6,
Kuniaki Hayashi1 and
Naofumi Matsunaga7
1 Department of Radiology, Nagasaki University School of Medicine, 1-7-1
Sakamoto, Nagasaki 852-8501, Japan.
2 Department of Radiology, Inoue Hospital, 8-9 Takaramachi, Nagasaki 852-0045,
Japan.
3 Department of Radiology, National Nagasaki Medical Center, 2-1001-1 Kubara,
Omura 856-0835, Japan.
4 Department of Radiology, Nagasaki Municipal Hospital, 6-39 Shinchi-machi,
Nagasaki 850-0842, Japan.
5 Second Department of Surgery, Nagasaki University School of Medicine, Nagasaki
852-8501, Japan.
6 Second Department of Internal Medicine, Nagasaki University School of
Medicine, Nagasaki 852-8501, Japan.
7 Department of Radiology, Yamaguchi University School of Medicine, 1-1-1
Kogushi, Ube, Yamaguchi 755-8505, Japan.
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Fig. 1A. —Intrahepatic bilomas developed after chemoembolization with
gelatin sponge and suspension of anticancer drugs and iodized oil in
70-year-old man with hepatocellular carcinoma. Left hepatic angiogram shows
hepatocellular carcinoma (arrows) with fine neovascularity in segment
IV.
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Fig. 1B. —Intrahepatic bilomas developed after chemoembolization with
gelatin sponge and suspension of anticancer drugs and iodized oil in
70-year-old man with hepatocellular carcinoma. Unenhanced CT scan obtained 2
weeks after chemoembolization shows dense accumulation of iodized oil in
tumor.
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Fig. 1C. —Intrahepatic bilomas developed after chemoembolization with
gelatin sponge and suspension of anticancer drugs and iodized oil in
70-year-old man with hepatocellular carcinoma. Contrast-enhanced CT scan
obtained 2 months after chemoembolization shows multiple intrahepatic bilomas
mimicking diffuse bile duct dilatation.
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Fig. 1D. —Intrahepatic bilomas developed after chemoembolization with
gelatin sponge and suspension of anticancer drugs and iodized oil in
70-year-old man with hepatocellular carcinoma. Endoscopic retrograde
cholangiogram shows mild stenosis and irregularity of proximal portion of left
hepatic duct (arrows). Dense accumulation of iodized oil in tumor
(arrowheads) is also seen.
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Fig. 1E. —Intrahepatic bilomas developed after chemoembolization with
gelatin sponge and suspension of anticancer drugs and iodized oil in
70-year-old man with hepatocellular carcinoma. On photograph showing gross
specimen, multiple intrahepatic bilomas are seen in lateral segment
(arrows). Complete necrosis of hepatocellular carcinoma
(arrowheads) is also seen in segment IV.
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Fig. 1F. —Intrahepatic bilomas developed after chemoembolization with
gelatin sponge and suspension of anticancer drugs and iodized oil in
70-year-old man with hepatocellular carcinoma. Microscopic image of
histopathologic specimen reveals bile leakage (arrowheads) and
coagulation necrosis and thrombosis of small hepatic arteries around necrotic
bile duct (arrows) that is slightly dilated. (H and E,
x175)
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Fig. 2A. —Intrahepatic bilomas developed after chemoembolization with
gelatin sponge and suspension of anticancer drugs and iodized oil in
71-year-old man with hepatocellular carcinoma. Contrast-enhanced CT scan
obtained 2 months after chemoembolization shows development of intrahepatic
biloma (arrows) in posterior segment.
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Fig. 2B. —Intrahepatic bilomas developed after chemoembolization with
gelatin sponge and suspension of anticancer drugs and iodized oil in
71-year-old man with hepatocellular carcinoma. Contrast-enhanced CT scan
obtained 4 months after chemoembolization shows interval shrinkage of biloma.
Biloma had completely resolved on 5-month follow-up CT (not shown).
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Fig. 3A. —Intrahepatic bilomas developed after chemoembolization with
gelatin sponge and mixture of anticancer drugs and iodized oil in 69-year-old
man with metastatic liver tumor caused by colon cancer. Contrast-enhanced CT
scan shows large tumor in right lobe of liver.
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Fig. 3B. —Intrahepatic bilomas developed after chemoembolization with
gelatin sponge and mixture of anticancer drugs and iodized oil in 69-year-old
man with metastatic liver tumor caused by colon cancer. Contrast-enhanced CT
scan obtained 1 month after chemoembolization shows development of
intrahepatic biloma (arrows) in segment VI.
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Fig. 3C. —Intrahepatic bilomas developed after chemoembolization with
gelatin sponge and mixture of anticancer drugs and iodized oil in 69-year-old
man with metastatic liver tumor caused by colon cancer. Photomicrograph of
histopathologic specimen reveals bile leakage (arrowheads) around
necrotic bile duct (arrows) and liver necrosis adjacent to biloma. (H
and E, x175)
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Copyright © 2003 by the American Roentgen Ray Society.
