Radiological Case

Pericardiobiliary Fistula: A Rare Complication of Penetrating Abdominal Trauma

Craig Chavez, MD; David Golchian, DO; Donald Conn, MD; John Finger, MD

Disclosures

Appl Radiol. 2018;47(8):24-26. 

In This Article

Case Summary

A 31-year-old man with past medical history of hypertension and status post-multiple thoracoabdominal gunshot wounds two weeks prior presented to the emergency department with chest pain and shortness of breath. The patient was treated at an outside hospital with bilateral chest tubes and discharged after 11 days without surgical intervention. Chest CT angiography and abdomen/pelvis CT obtained in the ED demonstrated a moderate pericardial effusion and moderate bilateral pleural effusions, as well as a trajectory injury/laceration of the liver involving the left and right hepatic lobes (Figures 1,2).

Figure 1.

Axial (A) and coronal (B) Noncontrast CT of the abdomen and pelvis demonstrate trajectory/laceration traversing the liver parenchyma to the diaphragmatic surface.

Figure 2.

Axial contrast-enhanced CT thorax demonstrates a moderate sized pericardial effusion.

The next day, the patient underwent left approach VATS with pericardial window and placement of a pericardial drain and bilateral thoracotomy tubes. Pericardial fluid analysis showed a total bilirubin of 38.4 g/dL and the patient was diagnosed with bile pericarditis. A HIDA scan was subsequently ordered and demonstrated extension of radiotracer activity into a tubular structure arising from the upper mid thorax and extending along the left lateral chest into a drainage catheter (Figure 3).

Figure 3.

HIDA scan images (A) and (B) demonstrate the extension of radiotracer activity above the diaphragm into the pericardium.

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