Hemobilia consists of an arteriobiliary fistula, usually due to central liver rupture with bleeding into the biliary tree. It is due to trauma in over 50% of cases, with an increasing incidence of iatrogenically caused hemobilia. The sonographic findings in two cases of traumatic hemobilia are presented and the literature is reviewed. These findings include clot within the gallbladder and the extrahepatic ducts, liver hematoma, and aneurysm of the hepatic artery.
In five cases of hepatic artery aneurysms, the findings on sonography suggested the diagnosis or indicated the need for angiography.The intrahepatic aneurysms (four cases) were anechoic, well-circumscribed masses with good through transmission of sound. None were pulsatile, but flow within the mass was observed in one case. An intrahepatic mass adjacent to the aneurysm was identified in every case, representing hematoma in three and postoperative abscess in one. The sonogram in a patient with a common hepatic artery aneurysm (one case) showed a lobulated, pulsatile, anechoic mass within a pancreatic head pseudocyst. Sonography offers a noninvasive means of screening for this abnormality.
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