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• W1569607494 abstract "A 74-year-old patient with end-stage renal disease on hemodialysis presented with 3 days of abdominal pain, nausea, and vomiting. He was afebrile and physical examination revealed both epigastric and right upper quadrant tenderness without a positive Murphy’s sign. Initial laboratory values were significant for slightly elevated levels of serum amylase (254 U/l) and lipase (2.5 U/dl) and a white blood cell count of 4.2 × 1000/cu mm. A right upper quadrant ultrasound revealed sludge in the gallbladder. No stones were evident in the biliary tree. However, based on the presence of echogenic foci and acoustic shadowing, concern for pneumobilia (Fig. 1) was raised by the radiologist. A surgical consultant recommended further evaluation of the patient with computed tomography (CT) scan of the abdomen (Fig. 2). Right upper quadrant sonogram revealing linear echogenic foci throughout the liver with a central focus of density and acoustic shadowing (arrow). Computed tomography scan of the abdomen showing hepatic arterial calcification (arrows), consistent with Mönckeberg’s arteriosclerosis of the liver. What is the cause of these radiologic findings? The right upper quadrant sonogram reveals linear echogenic foci throughout the liver with a central focus of density (Fig. 1). There was also distal acoustic shadowing (Fig. 1, arrow) thought to be consistent with pneumobilia or air in the biliary tree. A CT scan was performed 1 day later to confirm the diagnosis. Hepatic arterial calcification, consistent with Mönckeberg’s arteriosclerosis (without evidence of bile duct air or portal venous gas) was found to be the actual cause of the sonographic findings. Ultrasonography of the liver and biliary tree in patients with calcification of the hepatic arteries has been previously misinterpreted as pneumobilia. In fact, several case studies have described this phenomenon in both normal subjects and in patients with end-stage renal disease. The presence of hepatic arterial calcification causes distal acoustic shadowing on ultrasonography, a finding that is often indistinguishable from air in the biliary tree. As a result, patients may be misdiagnosed with a serious biliary infection. In patients with end-stage renal disease (in whom calcified vessels are common), hepatic artery calcifications should be considered in the differential diagnosis of sonographic pneumobilia. Evidence of splenic arterial calcification occurs early in the process of Mönckeberg’s arteriosclerosis and may provide a clue to the true nature of linear sonographic abnormalities in other organs." @default.
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• W1569607494 date "2008-08-28" @default.
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• W1569607494 title "Images in Dialysis Series Editors: Ursula C. Brewster and Mark A. Perazella: A Dialysis Patient with Apparent Air in the Biliary Tree" @default.
• W1569607494 doi "https://doi.org/10.1111/j.1525-139x.2008.00479.x" @default.
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