Hemobili

Özet

Hemobili, kanın hepatobiliyer sistemle iletişim kurarak safra yollarına veya safra kesesine geçmesidir; travma, biyopsi ya da biliyer girişim sonrası ortaya çıkabilir. BT anjiyografi, kanal içindeki kan/pıhtıyı ve kanamaya yol açan arteriyel psödoanevrizma ya da aktif ekstravazasyonu birlikte arar. BT'de safra kesesi veya koledokta yüksek dansiteli materyal kan pıhtısını düşündürebilir; BT bulguları özgül olmayabilir ve hemobili tanısını doğrulamak için ek görüntüleme veya klinik korelasyon gerekebilir. Aktif damar kaynağı veya pıhtıya bağlı obstrüksiyon gözden kaçarsa kanamanın yeri ve safra yolu tıkanmasının düzeyi belirsiz kalabilir.

Faz ve pencere

Kontrastsız

BT'de safra kesesi veya koledokta yüksek dansiteli materyal kan pıhtısını düşündürebilir.

Arteriyel tanısal

Karaciğer arter dalları ve girişim hattı boyunca damar havuzuyla aynı anda kontrastlanan yuvarlak psödoanevrizma veya safra yolu/karaciğer parankimine doğru aktif kontrast ekstravazasyonu aranır.

Portal

Safra yollarında lümen içi pıhtı, safra kesesinde kan içeriği, kanal genişlemesi ve eşlik eden karaciğer yaralanması ya da kitle değerlendirilir; arteriyel kaynak küçükse bu fazda seçilemeyebilir.

Önerilen pencereler: Anjiyo (G 600 / M 150), Karaciğer (G 150 / M 30), Batın (G 400 / M 50).

BT bulguları

• BT'de safra kesesi veya koledokta yüksek dansiteli materyal kan pıhtısını düşündürebilir.
• Koledokta kalıp biçimli lüminal materyal ve proksimal intrahepatik kanal genişlemesi; pıhtı ile obstrüksiyon birlikteliği.
• Arteriyel fazda hepatik arter dalı komşuluğunda arterle eş zamanlı kontrastlanan yuvarlak psödoanevrizma.
• Biliyer lümene doğru kontrast ekstravazasyonu veya karaciğer içinde giderek büyüyen kontrast havuzu.
• Biyopsi, perkütan transhepatik drenaj, ERCP veya travma traktı boyunca arteriyobiliyer fistül şüphesi.
• Eşlik eden karaciğer laserasyonu, subkapsüler/parankimal hematom veya hepatobiliyer tümör odağı.

Normalde

Hemobili şüphesinde BT bulguları özgül olmayabilir; BT anjiyografi kanamanın nedenini ve yerini değerlendirmeye yardımcı olur. Kıyasta hiperdens materyalin lümen içinde yerleşimini, arteriyel odakla devamlılığını ve proksimal kanal çaplarını kontrol et.

Ayırıcı tanı

Safra taşı

hemobili nedenleri arasında safra kesesi ve safra yolu taşları da yer alır; BT bulguları özgül olmayabileceğinden ek görüntüleme veya klinik korelasyon gerekebilir.

Safra çamuru ultrasonografide safra kesesinin en bağımlı bölümünde tabaka oluşturabilir.

Safra kesesi tümörü

hepatobiliyer maligniteler hemobili nedeni olabilir; BT bulguları özgül olmayabileceğinden ek görüntüleme veya klinik korelasyon gerekebilir.

Arteriyovenöz malformasyonda arteriyel fazda erken portal venöz dolum görülebilir.

Tuzaklar

• Kontrastsız BT'deki hiperdens lüminal materyal tek başına hemobili tanısı koydurmaz; kalsifiye taş, yoğun safra ve yakın kontrast atılımı dışlanmalıdır.
• Arteriyel ekstravazasyon aralıklı olabilir; aktif kaçak görünmemesi, pıhtı veya psödoanevrizma gibi dolaylı bulgular varken kanamayı dışlamaz.
• Biliyer dren kateteri çevresindeki küçük psödoanevrizma artefakt veya damar kesiti sanılabilir; kateter traktını ve ardışık ince kesitleri takip et.
• Yalnız portal faz çekilmiş incelemede küçük arteriyel kaynak atlanabilir; mevcut çekim protokolünün kanama sorusunu yanıtlayıp yanıtlamadığını belirt.

Kendini dene

1. BT anjiyografide hepatik arter psödoanevrizması ve safra yolu içinde kan pıhtısı görülüyor. En olası tanı nedir?

   • Hemobili
   • Bilhemi
   • Safra taşı
   • Portal ven trombozu
   Cevabı göster

   Hemobili. Hemobili, safra yollarına kanamayı ifade eder; arteriyel psödoanevrizma ve safra yolu içindeki pıhtı bu tanıyı destekler.

2. CTA kanama yerini göstermez ve hematokrit düşüklüğü sürerse kaynakta önerilen sonraki inceleme hangisidir?

   • Selektif intraarteriyel dijital çıkarma anjiyografisi
   • Kontrastsız abdominal BT
   • Safra kesesi ultrasonografisi
   • MRCP
   Cevabı göster

   Selektif intraarteriyel dijital çıkarma anjiyografisi. Kaynak, CTA kanama yerini gösteremediğinde ve hematokrit bozukluğu sürdüğünde selektif intraarteriyel dijital çıkarma anjiyografisi gerektiğini belirtiyor.

İlgili konular

• Pnömobili
• Safra çamuru ve yoğun safra

Kaynaklar

Bu sayfadaki 33 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla tek tek karşılaştırıldı; 6 cümle bu karşılaştırmada düzeltildi (2026-10-09).

1. Vascular complications in percutaneous biliary interventionspmc.ncbi.nlm.nih.gov
2. A Rare Case of Hemobilia due to Hepatic Artery Pseudoaneurysm (HAPA) in the right Hepatic Artery-Segment 8 branch and its Management via Coil Embolizationpmc.ncbi.nlm.nih.gov
3. Hemobilia: A Narrative Review of Current Diagnostic Techniques and Emerging Management Strategiespmc.ncbi.nlm.nih.gov
4. Portal cavernoma cholangiopathy: A systematic review of current understanding, clinical significance, and managementpmc.ncbi.nlm.nih.gov
5. Hemobilia caused by pancreatic arteriovenous malformationpmc.ncbi.nlm.nih.gov
6. Iatrogenic hepatopancreaticobiliary injuries: a review.pubmed.ncbi.nlm.nih.gov
7. Hepatic artery pseudoaneurysm caused by acute idiopathic pancreatitis.pubmed.ncbi.nlm.nih.gov
8. Hemobilia: Historical overview, clinical update, and current practices.pubmed.ncbi.nlm.nih.gov
9. Hemobilia: Perspective and Role of the Advanced Endoscopist.pubmed.ncbi.nlm.nih.gov
10. Unusual complications of gallstones.pubmed.ncbi.nlm.nih.gov
11. Hemobilia caused by pancreatic arteriovenous malformation: A case report and literature review.pubmed.ncbi.nlm.nih.gov
12. [Hemobilia secondary to hepatic artery pseudoaneurysm].pubmed.ncbi.nlm.nih.gov
13. Obstructive jaundice due to intraductal tumour thrombus in recurrent hepatocellular carcinoma: what is the optimal therapeutic approach?pubmed.ncbi.nlm.nih.gov
14. Hemobilia: An Uncommon But Notable Cause of Upper Gastrointestinal Bleeding.pubmed.ncbi.nlm.nih.gov
15. Imaging of hepato-pancreato-biliary emergencies in patients with cancer.pubmed.ncbi.nlm.nih.gov
16. Multidetector CT of emergent biliary pathologic conditions.pubmed.ncbi.nlm.nih.gov
17. Technique and indications of percutaneous cholecystostomy in the management of cholecystitis in 2014.pubmed.ncbi.nlm.nih.gov
18. Imaging of benign biliary pathologies.pubmed.ncbi.nlm.nih.gov
19. Hemobilia: A Narrative Review of Current Diagnostic Techniques and Emerging Management Strategies.pubmed.ncbi.nlm.nih.gov
20. Percutaneous Transhepatic Retrieval of Dysfunctional Plastic Biliary Stents.pubmed.ncbi.nlm.nih.gov
21. Portal cavernoma cholangiopathy: A systematic review of current understanding, clinical significance, and management.pubmed.ncbi.nlm.nih.gov
22. Endoscopic management of biliary leaks: Where are we now?pubmed.ncbi.nlm.nih.gov
23. Iatrogenic portobiliary fistula treated with covered stent following percutaneous transhepatic biliary drainage.pubmed.ncbi.nlm.nih.gov
24. Vascular complications in percutaneous biliary interventions.pubmed.ncbi.nlm.nih.gov
25. Case Report: Unveiling occult bleeding: a rare case of hemobilia diagnosed by peroral cholangioscopy.pubmed.ncbi.nlm.nih.gov
26. Endovascular Management of Hemobilia as a Complication of Percutaneous Biliary Drainage.pubmed.ncbi.nlm.nih.gov
27. Radiological Assessment After Pancreaticoduodenectomy for a Precision Approach to Managing Complications: A Narrative Review.pubmed.ncbi.nlm.nih.gov
28. Asian Conference on Tumor Ablation Guidelines for Hepatocellular Carcinoma.pubmed.ncbi.nlm.nih.gov
29. Hemobilia: Etiology, diagnosis, and treatment ☆ .pubmed.ncbi.nlm.nih.gov
30. Imaging Diagnosis of Splanchnic Venous Thrombosis.pubmed.ncbi.nlm.nih.gov
31. Post-liver transplant biliary complications: Current knowledge and therapeutic advances.pubmed.ncbi.nlm.nih.gov
32. A Review on the Management of Biliary Complications after Orthotopic Liver Transplantation.pubmed.ncbi.nlm.nih.gov
33. Commentary: an eye on PET quantification.pubmed.ncbi.nlm.nih.gov
34. Development of a user-friendly calculator for a pediatric split-bolus polytrauma computed tomography protocol.pubmed.ncbi.nlm.nih.gov
35. Imaging after percutaneous thermal and non-thermal ablation of hepatic tumour: normal appearances, progression and complications.pubmed.ncbi.nlm.nih.gov
36. Genicular Artery Embolization for Osteoarthritis Related Knee Pain: A Systematic Review and Qualitative Analysis of Clinical Outcomes.pubmed.ncbi.nlm.nih.gov
37. Long-term safety and effectiveness of the "OptEase" vena cava filter.pubmed.ncbi.nlm.nih.gov
38. High-affinity alphavbeta3 integrin targeted optical probe as a new imaging biomarker for early atherosclerosis: initial studies in Watanabe rabbits.pubmed.ncbi.nlm.nih.gov
39. Management of obstructive jaundice secondary to hemorrhagic cholecystitis following a high-altitude fall: A case report.pubmed.ncbi.nlm.nih.gov
40. The consequences of percutaneous transhepatic biliary drainage (PTBD) in patients with tumoral obstructive jaundice: A retrospective study and review of literature.pubmed.ncbi.nlm.nih.gov
41. Recurrent Bacteremia and Cholangitis From Eroded Hepatic Artery Pseudoaneurysm Coil Into the Common Hepatic Duct: A Rare Indication for Liver Transplantation.pubmed.ncbi.nlm.nih.gov
42. Hemorrhagic Cholecystitis in an Elderly Patient With Fall Syndrome: A Case Report.pubmed.ncbi.nlm.nih.gov
43. Percutaneous Transhepatic Biliary Intervention for The Management of Malignant Hilar Biliary Obstruction.pubmed.ncbi.nlm.nih.gov
44. Portal vein thrombosis in cirrhosis: A literature review.pubmed.ncbi.nlm.nih.gov
45. Complications and expected imaging findings after endoscopic retrograde cholangiopancreatography.pubmed.ncbi.nlm.nih.gov
46. Undifferentiated hepatic carcinoma with osteoclast-like giant cells: A case report and literature review.pubmed.ncbi.nlm.nih.gov
47. Local-Regional Treatment of Hepatocellular Carcinoma: A Primer for Radiologists.pubmed.ncbi.nlm.nih.gov
48. Unexpected hepatic lymphangiography during transcatheter arterial chemoembolization in a patient with hepatocellular carcinoma: a case report.pubmed.ncbi.nlm.nih.gov
49. The Use of Gadoxetic Acid-Enhanced MRI as a Diagnostic Tool in Cases of Biliary Atresia: A Two-Case Report.pubmed.ncbi.nlm.nih.gov
50. Imaging features, diagnosis, and clinical management of hepatic involvement in hereditary hemorrhagic telangiectasia: a case series report and literature review.pubmed.ncbi.nlm.nih.gov
51. Acute Hemorrhagic Cholecystitis with Large Hemoperitoneum: Treatment with Microcoil Embolization and Subsequent Cholecystectomy.pubmed.ncbi.nlm.nih.gov
52. Spontaneous bacteremia and spontaneous bacterial peritonitis share similar prognosis in patients with cirrhosis: a cohort study.pubmed.ncbi.nlm.nih.gov
53. Does laparoscopic surgery decrease the risk of atrial fibrillation after foregut surgery?pubmed.ncbi.nlm.nih.gov
54. Patterns of injury and violence in Yaoundé Cameroon: an analysis of hospital data.pubmed.ncbi.nlm.nih.gov
55. Imaging features of porto-sinusoidal vascular disorder in a case-control study: diagnostic value for differentiation from liver cirrhosis.pubmed.ncbi.nlm.nih.gov
56. Incidental Findings in Pediatric Patients: How to Manage Liver Incidentaloma in Pediatric Patients.pubmed.ncbi.nlm.nih.gov
57. Pediatric Primary Hepatic Tumors: Diagnostic Considerations.pubmed.ncbi.nlm.nih.gov
58. Gallbladder hemorrhage in a patient on apixaban: A rare cause of acute abdominal pain.pubmed.ncbi.nlm.nih.gov
59. Arteriobiliary Fistula and Post-traumatic Pseudoaneurysm in the Right Hepatic Artery.pubmed.ncbi.nlm.nih.gov
60. Rare causes of acute non-variceal upper gastrointestinal bleeding: A comprehensive review.pubmed.ncbi.nlm.nih.gov
61. Endovascular and Endoscopic Treatment of Hemobilia: A Report of Two Cases.pubmed.ncbi.nlm.nih.gov
62. Complications in Post-Liver Transplant Patients.pubmed.ncbi.nlm.nih.gov
63. Liver Trauma: Until When We Have to Delay Surgery? A Review.pubmed.ncbi.nlm.nih.gov
64. Diagnosis and Treatment of VOD/SOS After Allogeneic Hematopoietic Stem Cell Transplantation.pubmed.ncbi.nlm.nih.gov
65. Spectral Computed Tomography Angiography in Visceral Artery Aneurysms: Technical Principles and Clinical Applications.pubmed.ncbi.nlm.nih.gov
66. Post-operative complications of cholecystectomy: what the radiologist needs to know.pubmed.ncbi.nlm.nih.gov
67. Causes and predictors of unplanned reoperations within 30 days post laparoscopic pancreaticoduodenectomy: a comprehensive analysis.pubmed.ncbi.nlm.nih.gov
68. Interventional Endoscopic Ultrasonography: Advances in Application.pubmed.ncbi.nlm.nih.gov
69. Management of Hemodynamic Collapse After Liver Transplantation From Native Bile Duct Stump Hemorrhage with Gelfoam.pubmed.ncbi.nlm.nih.gov
70. Acute Necrotizing Pancreatitis Leading to Hemosuccus Pancreaticus and Hemorrhagic Shock in the Setting of Decompensated Cirrhosis.pubmed.ncbi.nlm.nih.gov
71. A novel concept on volumetric assessment and quantification of gastrointestinal bleed on computed tomography angiography: Observations based on a case series.pubmed.ncbi.nlm.nih.gov
72. The role of interventional radiology in the treatment of patients with pancreatic cancer.pubmed.ncbi.nlm.nih.gov
73. A Rare Case of Hemobilia due to Hepatic Artery Pseudoaneurysm (HAPA) in the right Hepatic Artery-Segment 8 branch and its Management via Coil Embolization.pubmed.ncbi.nlm.nih.gov
74. Noninvasive Imaging Prior to Biliary Interventions.pubmed.ncbi.nlm.nih.gov
75. Complications of lymphoma in the abdomen and pelvis: clinical and imaging review.pubmed.ncbi.nlm.nih.gov
76. Characteristics of common solid liver lesions and recommendations for diagnostic workup.pubmed.ncbi.nlm.nih.gov
77. Incidental left paraaortic mass in a patient with gall bladder adenocarcinoma: A diagnostic challenge.pubmed.ncbi.nlm.nih.gov
78. A Study on the Spectrum of Imaging Findings of Post-ERCP-Specific Complications: A Retrospective Descriptive Study.pubmed.ncbi.nlm.nih.gov
79. Unusual ivory-white gallstones identified during indocyanine green fluorescence-guided laparoscopic cholecystectomy: a rare case report.pubmed.ncbi.nlm.nih.gov
80. Tumefactive Sludge Mimicking Gallbladder Neoplasm: A Case Report and Review of the Literature.pubmed.ncbi.nlm.nih.gov
81. Sprue-Like Enteropathy and Liver Injury: A Rare Emerging Association with Olmesartan.pubmed.ncbi.nlm.nih.gov
82. Modern Cyanine Dye-Based Photosensitizers for Medical Applications.pubmed.ncbi.nlm.nih.gov
83. Cross-sectional imaging after pancreatic surgery: The dialogue between the radiologist and the surgeon.pubmed.ncbi.nlm.nih.gov
84. Liver metastases: The role of magnetic resonance imaging.pubmed.ncbi.nlm.nih.gov
85. The diagnostic value of virtual unenhanced spectral CT images in acute pancreatitis: a comparison with true unenhanced images.pubmed.ncbi.nlm.nih.gov
86. Construction and validation of a diagnostic model for acute suppurative cholecystitis in older patients: LASSO-Logistic regression analysis using readily available clinical indicators.pubmed.ncbi.nlm.nih.gov
87. Obstructive jaundice with duodenal biliary fistula: diagnostic and therapeutic challenges, case report, and literature review.pubmed.ncbi.nlm.nih.gov
88. A Multidisciplinary Approach to Pancreas Cancer in 2016: A Review.pubmed.ncbi.nlm.nih.gov
89. Post-operative imaging in liver transplantation: state-of-the-art and future perspectives.pubmed.ncbi.nlm.nih.gov
90. Parasitic diseases as a cause of acute abdominal pain: imaging findings.pubmed.ncbi.nlm.nih.gov
91. Duodenal Obstruction and Grade III Acute Cholangitis Following Pancreaticoduodenal Artery Aneurysm Rupture During Conservative Management of Acute Type B Aortic Dissection: A Case Report.pubmed.ncbi.nlm.nih.gov
92. Precordial pain caused by a hemocholecyst due to gallbladder cancer: A case report.pubmed.ncbi.nlm.nih.gov
93. Intramural gallbladder hematoma mimicking gallbladder neoplasm in a 55-year-old male patient.pubmed.ncbi.nlm.nih.gov
94. Delayed hepatic artery pseudoaneurysm with arterioportal fistula after penetrating liver trauma successfully treated with coil embolization: a case report and focused literature review.pubmed.ncbi.nlm.nih.gov
95. Management of gastrointestinal bleed in the intensive care setting, an updated literature review.pubmed.ncbi.nlm.nih.gov
96. Balloon-Occluded Transarterial Chemoembolization for Hepatocellular Carcinoma: Technical Rationale, Current Evidence, and Future Directions.pubmed.ncbi.nlm.nih.gov
97. Migration of a Giant Gallstone Through a Therapeutic Cholecystocutaneous Fistula: A Case Report.pubmed.ncbi.nlm.nih.gov
98. Multimodal imaging features to diagnose abdominal complications of sickle cell disease.pubmed.ncbi.nlm.nih.gov
99. Diagnosis and treatment of hemosuccus pancreaticus induced by intraductal papillary mucinous neoplasm: a case report and review of the literature.pubmed.ncbi.nlm.nih.gov
100. A Case of Acute Pancreatitis Associated with Early-Stage Adenocarcinoma of the Gallbladder.pubmed.ncbi.nlm.nih.gov
101. Hepatic Arterioportal Fistula in Patients with Cirrhosis with Endovascular Management-A Series of 4 Cases with Review of Literature.pubmed.ncbi.nlm.nih.gov
102. Ablation manual for liver cancer.pubmed.ncbi.nlm.nih.gov
103. Hemosuccus Pancreaticus from Large Inferior Pancreaticoduodenal Artery Pseudoaneurysm Complicating Chronic Pancreatitis.pubmed.ncbi.nlm.nih.gov
104. A canine case of multiple intrahepatic portosystemic shunts.pubmed.ncbi.nlm.nih.gov
105. The Role of Imaging in Portal Vein Thrombosis: From the Diagnosis to the Interventional Radiological Management.pubmed.ncbi.nlm.nih.gov
106. Non-perforated peptic ulcer disease: multidetector CT findings, complications, and differential diagnosis.pubmed.ncbi.nlm.nih.gov
107. Imaging of malignancies of the biliary tract- an update.pubmed.ncbi.nlm.nih.gov
108. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) as a double-edged sword: leveraging imaging evaluation to maximize benefits and mitigate risks.pubmed.ncbi.nlm.nih.gov
109. Arterial and biliary complications after transarterial chemoembolization for hepatocellular carcinoma.pubmed.ncbi.nlm.nih.gov
110. All About Multiparametric MRI Evaluation in Biliary Tree Complications After Liver Transplant.pubmed.ncbi.nlm.nih.gov
111. Current insights into the diagnosis and management of small bowel bleeding.pubmed.ncbi.nlm.nih.gov
112. Right hepatic artery pseudoaneurysm caused by stone extraction-related trauma during endoscopic retrograde cholangiopancreatography: a case report.pubmed.ncbi.nlm.nih.gov
113. Upper gastrointestinal hemorrhage caused by cholecystolithiasis compressing the cystic artery: a case report.pubmed.ncbi.nlm.nih.gov
114. Bio-Memristor Based on Clinical Bile Samples: A Proof-of-Concept Pilot Study for Detection of Gallbladder Cancer.pubmed.ncbi.nlm.nih.gov
115. Case Report: Intrahepatic arterioportal fistula (IAPF)-a rare cause of hemobilia.pubmed.ncbi.nlm.nih.gov

Eğitim amaçlıdır; hasta başında tanı ve tedavi kararının yerine geçmez. İçerik yapay zekâ destekli bir süreçle güncel literatüre göre cümle cümle kaynaklarla karşılaştırıldı, ancak uzman radyolog incelemesinden geçmedi. Klinik kararlarda güncel kılavuzları, kurum protokollerini ve radyoloji raporunu esas alın.