Spontaneous perforation of gallbladder with intrahepatic biloma formation: sonographic signs and correlation with computed tomography

Spontaneous perforation of gallbladder is a severe and infrequent complication of acute cholecystitis that requires early and accurate diagnosis. Concomitant development of intrahepatic collections is rarely observed in such cases. The present report emphasizes the relevance of imaging studies in this setting, describing the typical sonographic and tomographic findings for the diagnosis of such condition.

Gallbladder; Spontaneous rupture; Ultrasonography; Computed tomography

Authorship

Erick Sabbagh de Hollanda

MDs, Residents, Service of Radiology and Imaging Diagnosis of Hospital de Base – Faculdade de Medicina de São José do Rio Preto (Famerp), São José do Rio Preto, SP, BrazilFaculdade de Medicina de São José do Rio PretoBrazilSão José do Rio Preto, SP, BrazilMDs, Residents, Service of Radiology and Imaging Diagnosis of Hospital de Base – Faculdade de Medicina de São José do Rio Preto (Famerp), São José do Rio Preto, SP, Brazil

Ulysses dos Santos Torres

Fabiana Gual

Eduardo Portela de Oliveira

Luciana Vargas Cardoso

MD, Radiologist, Head of the Unit of Computed Tomography, Service of Radiology and Imaging Diagnosis, Hospital de Base – Faculdade de Medicina de São José do Rio Preto (Famerp), São José do Rio Preto, SP, BrazilHospital de BaseBrazilSão José do Rio Preto, SP, BrazilMD, Radiologist, Head of the Unit of Computed Tomography, Service of Radiology and Imaging Diagnosis, Hospital de Base – Faculdade de Medicina de São José do Rio Preto (Famerp), São José do Rio Preto, SP, Brazil

Divanei Aparecida Bottaro Criado

Fellow Master degree in Health Sciences, MD, Radiologist, Unit of Ultrasonography, Service of Radiology and Imaging Diagnosis, Hospital de Base – Faculdade de Medicina de São José do Rio Preto (Famerp), São José do Rio Preto, SP, BrazilHospital de BaseBrazilSão José do Rio Preto, SP, BrazilFellow Master degree in Health Sciences, MD, Radiologist, Unit of Ultrasonography, Service of Radiology and Imaging Diagnosis, Hospital de Base – Faculdade de Medicina de São José do Rio Preto (Famerp), São José do Rio Preto, SP, Brazil

Mailing Address: Dr. Ulysses dos Santos Torres. Hospital de Base da Faculdade de Medicina de São José do Rio Preto, Serviço de Radiologia e Diagnóstico por Imagem. Avenida Brigadeiro Faria Lima, 5544, Vila São Pedro. São José do Rio Preto, SP, Brazil, 15090-000. E-mail: usantor@yahoo.com.br.

SCIMAGO INSTITUTIONS RANKINGS

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Figure 1.
A: Sonographic findings demonstrating subtle GB wall thickening, pericholecystic fluid and presence of GB sludge. B,C: Also, an extensive defect (perforation) is observed in the anterior wall of the GB (hole sign), with development of a predominantly anechoic perihepatic collection suggestive of biloma.

Thumbnail

Figure 2.
A,B: Axial sections, portal phase of abdominal computed tomography revealing the GB with a thickened and enhancing wall, pericholecystic fluid, an area of wall defect (perforation) (tomographic hole sign), besides the presence of a homogeneously hypodense, non-enhancing, subcapsular intrahepatic collection, suggestive of biloma. Observe the additional findings of foci of gross pancreatic calcifications and dilated Wirsung and choledocal ducts. C,D: Coronal reconstructions of portal phase confirm the previous findings, demonstrating the cause of the process (impacted calculus in the duodenal papilla), and more clearly depicting the intrahepatic, subcapsular nature of the biloma.

Figure 1. A: Sonographic findings demonstrating subtle GB wall thickening, pericholecystic fluid and presence of GB sludge. B,C: Also, an extensive defect (perforation) is observed in the anterior wall of the GB (hole sign), with development of a predominantly anechoic perihepatic collection suggestive of biloma.

Figure 2. A,B: Axial sections, portal phase of abdominal computed tomography revealing the GB with a thickened and enhancing wall, pericholecystic fluid, an area of wall defect (perforation) (tomographic hole sign), besides the presence of a homogeneously hypodense, non-enhancing, subcapsular intrahepatic collection, suggestive of biloma. Observe the additional findings of foci of gross pancreatic calcifications and dilated Wirsung and choledocal ducts. C,D: Coronal reconstructions of portal phase confirm the previous findings, demonstrating the cause of the process (impacted calculus in the duodenal papilla), and more clearly depicting the intrahepatic, subcapsular nature of the biloma.

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Spontaneous perforation of gallbladder with intrahepatic biloma formation: sonographic signs and correlation with computed tomography

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[1] Mailing Address: Dr. Ulysses dos Santos Torres. Hospital de Base da Faculdade de Medicina de São José do Rio Preto, Serviço de Radiologia e Diagnóstico por Imagem. Avenida Brigadeiro Faria Lima, 5544, Vila São Pedro. São José do Rio Preto, SP, Brazil, 15090-000. E-mail: usantor@yahoo.com.br.