Pneumobilia

Editor-In-Chief: Prab R Tumpati, MD
Obesity, Sleep & Internal medicine
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Pneumobilia
Pneumobilia as seen on imaging
Synonyms	Aerobilia
Pronounce	N/A
Specialty	N/A
Symptoms	Often asymptomatic, but may include abdominal pain, nausea, and vomiting
Complications	Cholangitis, biliary colic
Onset	Can be acute or chronic
Duration	Variable, depending on underlying cause
Types	N/A
Causes	Biliary-enteric fistula, endoscopic retrograde cholangiopancreatography (ERCP), sphincterotomy, biliary stent placement
Risks	Gallstone disease, peptic ulcer disease, trauma
Diagnosis	Ultrasound, CT scan, MRI
Differential diagnosis	Pneumoperitoneum, portal venous gas
Prevention	N/A
Treatment	Address underlying cause, may include surgery or endoscopic intervention
Medication	N/A
Prognosis	Depends on underlying cause and treatment
Frequency	Rare
Deaths	N/A

Pneumobilia refers to the presence of air within the biliary tree, which is an abnormal finding typically identified through imaging studies such as X-ray, ultrasound, or CT scan. This condition can be indicative of various underlying pathologies and requires careful evaluation to determine the cause.

Causes

Pneumobilia can result from several different conditions, including:

• Biliary-enteric anastomosis: Surgical connections between the bile ducts and the intestines can introduce air into the biliary system.
• ERCP: This procedure can introduce air into the biliary tree as a result of instrumentation.
• Biliary fistula: An abnormal connection between the bile ducts and the gastrointestinal tract can allow air to enter the biliary system.
• Infection: Certain infections, such as those caused by gas-forming organisms, can lead to pneumobilia.
• Gallstone ileus: A rare condition where a gallstone erodes into the intestinal tract, potentially allowing air to enter the biliary tree.

Diagnosis

The diagnosis of pneumobilia is primarily made through imaging studies. On an abdominal X-ray, pneumobilia may appear as branching radiolucencies in the right upper quadrant of the abdomen. Ultrasound may show echogenic foci with posterior acoustic shadowing or reverberation artifacts. CT scan is highly sensitive and can provide detailed images of air within the biliary tree.

Clinical Significance

While pneumobilia itself is not a disease, it is a sign that warrants further investigation to determine the underlying cause. The presence of air in the biliary tree can be associated with serious conditions that may require medical or surgical intervention.

Management

Management of pneumobilia depends on the underlying cause. If it is due to a benign cause such as a recent ERCP, no treatment may be necessary. However, if it is due to a pathological condition such as a biliary fistula or infection, appropriate medical or surgical treatment is required.

See also

• Biliary tract
• Cholangitis
• Gallbladder
• Liver