Pneumobilia – radiograph

Pneumobilia. Gas in the biliary tree (indicated by the white arrow in this case) is a common finding and is nearly always due to previous intervention, for example a sphincterotomy at ERCP, a CBD stent, or a hepaticojejunostomy. When there has been no previous surgery, potential causes for this appearance include infection (cholangitis) with a gas-forming organism, or a fistula between the gallbladder and duodenum (which can result in a gallstone obstructing the small bowel, i.e. ‘gallstone ileus’). In this case the pneumobilia is due to the metallic CBD stent (yellow arrow). When you see a metallic (as opposed to plastic) CBD stent it generally means that there is an underlying malignancy – this patient had inoperable pancreatic cancer. The patient also had a DVT and a contra-indication to anticoagulation, hence the IVC filter (purple arrow).