Presentation
Abdominal pain status post liver biopsy.
Patient Data
Core needle liver biopsy of liver lesion in a patient with known treated breast cancer.
CT scans performed before and after liver biopsy. There is a change in diffuse internal density of the common bile duct status post-biopsy secondary to hemobilia.
Pre-biopsy: Common bile duct is normal in size (status post cholecystectomy) and density.
Post-biopsy: Common bile duct has new diffuse internal hyperdensity status post liver biopsy compared to prior CT performed one week prior.
There is a change in common bile duct (CBD) internal intensity status post liver biopsy. Pre-biopsy MRI demonstrates normal internal hyperintensity of CBD. Post-biopsy demonstrates heterogenous low T2 and mild T1 in phase hyperintensity. The post contrast T1 fat sat image has internal mild hyperintense debris. Findings are consistent with hemobilia after recent liver biopsy.
Incidental findings are liver, pancreatic, and renal cysts. Patient has known liver lesions suspicious for metastatic disease, likely from known treated breast cancer, hence the liver biopsy. The biopsy was inconclusive.
After biopsy patient had an elevated lipase with imaging findings keeping with mild pancreatitis, secondary to hemobilia.
Annotation points to normal pre-biopsy CBD. Compare this internal T2 intensity with the post-biopsy MRI.
Case Discussion
Hemobilia is the presence of blood in the biliary tree.
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