Bilioma

Biliary leakage or perforation does not necessarily result in the full-blown picture of choleperitoneum. Much more common is the localized collection of bile, the so-called bilioma. The internal texture of the bilioma is echogenic, or may be characterized by streaking (Fig. 8.38). Only “fresh” bile will be anechoic. Biliomas are found in the vicinity of the biliary tree.

Hematoma

If there is no frank hemorrhage into the abdominal cavity, a hematoma may be formed within the smaller compartments. With aging, the intra-abdominal hematoma will become more and more hyperechoic and will display an internal texture. Over the course of the hematoma, it may demonstrate not only the more organized echogenic parts but also liquid regions undergoing liquefaction (Fig. 8.39).

Fig. 8.38 Localized anechoic liquid structure below the liver after dislocated left-sided PTCD, corresponding with a bilioma. Color flow Doppler imaging will help differentiate it from a solid mass.

Fig. 8.39 Status post hemorrhage under anticoagulant therapy: hypoechoic inhomogeneous paracolic structure, corresponding with a localized hematoma becoming organized.

In the case of a localized hyperechoic structure, the sonographer should primarily think of accumulated gas, e. g., localized perforation or gas abscess between the bowel loops.

Localized Perforation

Gas Abscess