Hemobilia: computed tomographic diagnosis

Abstract

A case of postbiopsy hemobilia is presented in which computed tomographic (CT) scanning showed blood within the gallbladder appearing as high-density material measuring 67-91 HU. Residual clots were seen by CT and ultrasound 8 days after the acute episode. These findings were confirmed by serial CT scans in two monkeys in whom blood was experimentally injected into the gallbladder. When the cystic duct is patent, the diagnosis of hemobilia may be excluded if bile of normal density (0-20 HU) is demonstrated by CT scanning. However, when homogeneous or inhomogeneous material of high attenuation (50+ HU) is present in the gallbladder on CT scanning, the diagnosis of hemobilia is strongly suggested if other causes such as stone or contrast material have been eliminated. CT may show residual blood for days after the acute episode.