Sonographic Diagnosis of Biloma in Severe Traumatic Liver Injury

A 41-year-old man presented to the emergency department after a pedestrian traffic accident. The initial vital signs were unstable: systolic blood pressure, 80 mm Hg; pulse rate, 56 beats/min; respiration rate, 16 breaths/min; body temperature, 36.0°C; and oxygen saturation, 95%. Early abdominal computed tomography (CT) of the right side of the liver showed American Association for the Surgery of Trauma (AAST) grade IV injury, according to the Organ Injury Scale (OIS) score, with extravasation of contrast material (Fig. 1.). On the same day, hepatic artery angiography showed active bleeding in segments 5, 7, and 8, and embolization was performed (Fig. 2.). Liver enzyme levels (aspartate aminotransferase, 1036 IU/L; alanine transferase, 1192 IU/L) were highest on day 3 after admission. No extravasation of contrast material was observed on abdominal CT performed on day 3 (Fig. 3.). On day 5, the patient developed abdominal pain in the right upper quadrant. The focus of pain was more lateral than the location of the gallbladder on initial abdominal CT, and tenderness was also observed on physical examination. On abdominal ultrasonography, biloma was observed in the hepatic dome. Therefore, percutaneous drainage was performed (Fig. 4.). Biloma was still observed on abdominal CT 2 weeks later (Fig. 5.).