Fig. 18

One month after evacuation of the haemoperitoneum and subcapsular hepatic haematoma, the same patient in Fig. 10 suffered form right-sided thoraco-abdominal pain and fever. Arterial- (a) and venous-phase (b) CT showed a huge, fluid-attenuating (15 HU) subphrenic collection (*) with inflammatory enhancement of the surrounding, compressed liver parenchyma (+) and thin peripheral enhancement, consistent with an abscess. Ipsilateral pleural effusion and basal lung atelectasis were associated. Percutaneous drainage yielded 3 l of stinking pus. Note the correctly positioned metallic CBD stent (arrowheads), and clinical, laboratory and imaging (* in c) resolution was obtained. During endoscopic replacement, the biliary stent was not found anymore (d), displaced and probably lost with stools. Endoscopic cholangiogram (e) confirmed persistent iatrogenic biliary stricture (arrow). Follow-up MRI (T2-weighted image in f) showed resolved subphrenic abscess with low signal intensity consistent with fibrosis (*)