Detecting biliary complications following liver transplantation with contrast-enhanced ultrasound

Figure 4 A 60-year-old male patient who underwent liver transplantation for primary biliary cirrhosis. Twelve days postoperatively, an ultrasound examination revealed a biliary duct fistula. A and B: Two-dimensional ultrasound and color Doppler ultrasound showed that a large anechoic area with an irregular shape and good acoustic transmission was visible in the hepatic hilum, measuring approximately 200 mm × 46 mm, with no significant blood flow signals observed internally; C: Intravenous contrast-enhanced ultrasound showed no internal enhancement, with clear margins (indicated by the arrow); D: Endoscopic retrograde cholangiopancreatography showed that a catheter was successfully inserted, and a small amount of 10% Ultravist (Shering, Berlin, Germany) was injected. A narrow segment, approximately 8 mm long, was visible at the biliary duct anastomosis, and a fistula was observed in the intrahepatic biliary duct on the left side of the liver. The contrast agent infiltrated into the extrahepatic liver through the fistula (indicated by the arrow).