Radiological Case

Pericardiobiliary Fistula: A Rare Complication of Penetrating Abdominal Trauma

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


Appl Radiol. 2018;47(8):24-26. 

In This Article

Imaging Findings

A CT of the abdomen through the level of the hepatic dome (1A) shows a large laceration with a trajectory towards the inferior margin of the pericardium. Coronal CT shows the extent of the liver parenchyma laceration and presence of pericardial effusion. The spleen and the gastrointestinal structure are intact. The moderate amount of pericardial effusion is better demonstrated in the images through the level of the heart where moderate amount of pericardial effusion as well as bilateral pleural effusions. Two-view HIDA scan images demonstrate radiotracer activity that arises from gallbladder fossa and courses superolateral towards the pericardium before exiting out the left chest pericardial drainage catheter. ERCP image shows left intrahepatic bile duct injury with leakage of contrast above the liver and extending towards the thoracic cavity (Figure 4).

Figure 4.

Endoscopic retrograde cholangiopancreatography image demonstrating disruption of the left intrahepatic bile duct.