Demonstration of an occult biliary‐arterial fistula using percutaneous contrast‐enhanced ultrasound cholangiography in a transplanted liver

Abstract

We present a case of a biliary-arterial communication as a consequence of the placement of an internal-external biliary drainage catheter in a liver transplant patient diagnosed on contrast-enhanced ultrasound using a novel application by injecting microbubble contrast into the catheter tube. We postulate that this method may be sensitive in identifying occult communications between the biliary tree and the vascular compartment when a catheter drain is positioned, and there is hemobilia or unexplained sepsis.

Guidelines and Good Clinical Practice Recommendations for Contrast Enhanced Ultrasound (CEUS) in the Liver – Update 2020 – WFUMB in Cooperation with EFSUMB, AFSUMB, AIUM, and FLAUS

“…CEUS-guided percutaneous cholangiography can delineate the biliary tree via drainage catheters, T-tubes placed intraoperatively, or during endoscopic access [206][207][208][209][210][211][212][213][214][215][216]. Intraoperatively, 3D-intracavitary CEUS can aid the surgeon to plan resection lines [206][207][208][209][210][211][212][213][214][215][216].…”

“…Intracavitary CEUS of the biliary tree is used ▪ during the intervention procedure to demonstrate puncture or cannulation success to evaluate for communication with other structures, e. g. intestine [214], pleural cavity [206,207], gall bladder, vessels [210], abscesses or others to evaluate the level of obstruction [216] ▪ after the interventional procedure to evaluate for dislodgement or occlusion.…”

Intravenous and Intracavitary Use of Contrast‐Enhanced Ultrasound in the Evaluation and Management of Complicated Pediatric Pneumonia

“…Importantly, it can also effectively provide information on possible communication of the collection with the surrounding structures. This technique has been shown to be successful when applied to biliary drains, where it can display the biliary tree in a precise way, determine the level of obstruction, and show complications such as fistulas to vascular structures …”

Contrast-enhanced ultrasound (CEUS) in abdominal intervention

“…10 ). It has also been reported that CEUS cholangiography can reveal complications associated with the percutaneous trans-hepatic biliary drainage, such as an arterial communication with a percutaneous biliary drainage tube [ 45 ], due to its superior temporal and spatial resolution. Furthermore, evaluation of post-surgical complications such as a bile leakage can be performed with CEUS (Fig.…”