Tx and Followup:
A hepatobiliary scan revealed radiotracer uptake surrounding the liver consistent with a bile leak into a biloma with subsequent drainage through the right upper quadrant drain.
An ERCP confirmed extravasation of contrast from the cystic duct.
During the ERCP, a biliary stent was placed. A follow-up CT performed 6 days after the ERCP showed near complete resolution of the subcapsular fluid.
CT scans detect perihepatic fluid well, but they fail to accurately identify whether the fluid is bilious or, more importantly, if the fluid arose from a communication with the biliary tree. Tc-99m labeled hepatobiliary scanning is a well-known modality that provides excellent physiologic evaluation of bile leaks.