UMEM Educational Pearls


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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