Intrahepatic biloma after transcatheter arterial chemoembolization: evaluation of imaging findings, clinical course and treatment

We evaluated the imaging findings, clinical course and treatment of biloma after transcatheter arterial chemoemolization (TACE) of hepatocelluar carcinoma (HCC). After TACE of HCC in 11 patients with intrahepatic biloma, the findings of dynamic CT and angiography were retrospectively analysed. Hemodynamic change occurring in the hepatic artery and portal vein, the presence of intrahepatic bile duct dilatation, and serum bilirubin levels were analyzed. Changes in the size of the biloma at follow-up study, the extent of additional management, and the overall clinical course were also analyzed. Hepatic artery obliteration was observed in all cases; this involved the right hepatic artery in eight, and the segmental artery in three. There was decreased portal venous flow in seven cases and portal thrombosis in one. The intrahepatic duct was dilated in all cases but significantly elevated serum bilirubin levels were not noted. Follow-up study showed that in five cases the size of the biloma had increased; in four of these there was infection, and drainage was performed. In the remaining six cases the size of the biloma did not change, even where a segment or lobe had atrophied. Angiography showed that after TACE hepatic arterial obliteration occurred in all patients with intrahepatic biloma after TACE. During infection or where a biloma has increased in size, intervention is required