Fig. 1.

Infected biloma complicating radioembolization. A 65-year-old man with recurrence following partial hepatectomy and pancreaticoduodenetomy for metastatic pancreatic neuroendocrine tumor. Contrast-enhanced coronal MR image demonstrates a segment 4 metastatic tumor (white arrow) ( a ). The lesion was treated with ablative-dose segmental radioembolization (radiation segmentectomy); posttreatment bremsstrahlung-fused coronal SPECT/CT image reveals deposition of the Y-90 microspheres in the target segment (tan) ( b ). Despite a 3-week course of prophylactic oral antibiotics, the patient returned with fevers and pain 3 months after treatment. Coronal image from CT chest shows a large intrahepatic abscess (arrow = gas in the abscess cavity) ( c ). This was treated with antibiotics and percutaneous drainage. At a subsequent drain revision, injection of the abscess catheter reveals communication with the bile ducts (black arrow) ( d ). Ultimately, the infected biloma resolved, the drain was removed, and the metastatic tumor showed complete response.