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Bronchobiliary fistula detected by cholescintigraphy
M G Velchik1, G M Roth, W Wegener
1Department of Radiology, Hospital of The University of PA, Philadelphia 19104.
Summary
A rare bronchobiliary fistula was diagnosed using hepatobiliary scintigraphy in a patient with cholangiocarcinoma. This condition, presenting as bilioptysis, occurred 18 months post-surgery.
Area of Science:
- Gastroenterology and Hepatology
- Thoracic Surgery
- Diagnostic Imaging
Background:
- Cholangiocarcinoma necessitates complex surgical interventions like right hepatic lobectomy and common bile duct resection.
- Post-surgical complications can include abscess formation and fistulous tracts.
- Bilioptysis, the expectoration of bile, is a rare but significant symptom indicating abnormal biliary-enteric or biliary-pulmonary communication.
Observation:
- A patient presented with bilioptysis 18 months after undergoing surgery for cholangiocarcinoma.
- The patient had a history of a right hepatic lobectomy and common bile duct resection.
- A subphrenic abscess complicated the initial surgery, requiring percutaneous biliary drainage.
Findings:
- Hepatobiliary scintigraphy was instrumental in the initial detection of a bronchobiliary fistula.
- The fistula manifested as bilioptysis, a rare clinical presentation.
- The fistula developed in the context of prior complex abdominal surgery and complications.
Implications:
- Early and accurate diagnosis of bronchobiliary fistulas is crucial for effective management.
- Hepatobiliary scintigraphy serves as a valuable diagnostic tool for detecting such complex fistulas.
- Understanding the potential for delayed complications like bronchobiliary fistula formation is important in long-term patient follow-up after liver surgery.
