UMEM Educational Pearls

Title: What's the Diagnosis? Guest submission by #ChileEM Dr. Pedro Verdugo

Category: Visual Diagnosis

Posted: 1/11/2016 by Haney Mallemat, MD (Updated: 3/10/2016)
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What’s the name of this CT finding and name two potential causes?

Pneumobilia (air in the biliary tree). Be careful, this must be distinguished from portal venous gas.

Diagnoses to consider when pneumobilia is present:

Infection
- Cholangitis
- Liver abscess communicating with biliary tree
- Emphysematous cholecystitis
Biliary instrumentation (e.g., recent ERCP)
Incompetent sphincter or Oddi
- passage of a gallstone
- sphincterotomy
- certain medications
Biliary-enteric fistula (e.g., Peptic ulcer disease, gallstone ileus, trauma,, etc.)

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