The differential diagnosis of Chilaiditi's syndrome includes pneumoperitoneum,
pneumobilia, and hepatic-portal venous gas.
10
Pneumobilia is a common finding and is due to either the reflux of enteric gas from stone passage across the ampulla or due to infection with gas-forming organisms.
The addition of T1-weighted gradient echo in phase images to standard MRCP sequences improves the detection and differentiation of hepatolithiasis and intrahepatic
pneumobilia.
In a patient with gallstone ileus, imaging studies typically show a classic radiographic triad (Rigler's triad) consisting of small bowel obstruction,
pneumobilia, and an ectopic gallstone.
The classic Riglers triad of radiography includes mechanical bowel obstruction
pneumobilia and an ectopic gallstone within bowel lumen.
A repeat ultrasound scan showed
pneumobilia with no biliary dilatation or mass.
Enlarged biliary ducts with thickened walls in the left hepatic lobe, and hyperechoic biliary ducts with posterior reverberation in the right lobe--suggestive for cholangitis and
pneumobilia (figure 1);
A CT scan of the abdomen and pelvis showed gallstone-induced inflammatory changes about the duodenum consistent with duodenitis as well as the presence of
pneumobilia (Figure 1).
6 Non-Operative Management of
Pneumobilia following Blunt Abdominal Trauma: A Case Report and Review of the Literature.
Pneumobilia is well recognised in adults in the context of gallstone ileus and after endoscopy.
One case of partially distended GB having air fluid level and
pneumobilia (Fig: E red arrow) was seen along with gall stone ileus, where the calculus was in the ileum in CECT abdomen (Fig: E white arrow).
6-8) This is also the preferred biliary anastomosis in pediatric patients, in which case resultant
pneumobilia is often present.
