Ultrasound-Guided CEUS in Biloma Management: A Comprehensive Overview

A biloma is an abnormal, well-defined accumulation of bile outside the biliary tree, which can be either intra- or extra-hepatic in nature. It often results from trauma or iatrogenic causes, leading to bile leakage and potential complications. Timely diagnosis and appropriate management of bilomas are essential to prevent morbidity and mortality. Magnetic resonance cholangiopancreatography (MRCP) is typically used for diagnosis, but it may not always provide definitive results. This case details a 72-year-old woman who underwent hepatic resection of the seventh segment after recurrence of hepatocellular carcinoma (HCC). During follow-up ultrasound (US), a peri-hepatic collection was identified, later confirmed as a biloma, continuously replenished by bile from the biliary tree. Although MRCP and percutaneous transhepatic cholangiography (PTC) failed to clearly detect the site of the bile leak, Contrast-Enhanced Ultrasound (CEUS) was employed to further investigate. By administering the contrast agent through the percutaneous drainage catheter placed in the biloma, CEUS revealed the flow of contrast from the collection to a peripheral right bile duct, confirming communication between the biloma and an intra-hepatic leak. This case illustrates that CEUS is a straightforward, safe, and effective diagnostic tool for detecting biliary leakage responsible for biloma formation. In addition to providing precise results, CEUS offers the advantages of minimizing radiation exposure for the patient and eliminating the need for anesthesia, unlike conventional imaging methods. As a non-invasive and reliable diagnostic modality, CEUS presents a valuable alternative for the management of bilomas, ensuring prompt detection and aiding in the effective treatment of biliary leakage. This case suggests that CEUS should be considered as an important tool in the diagnostic workup of bilomas, particularly when other methods fail to provide clear results.