Fig. 23. Post-transplant hepatic artery thrombosis with secondary biliary necrosis and biloma formation: a 52-year-old woman with a history of liver transplantation 2 months ago presented with jaundice and abnormal liver function tests.

A. Color Doppler ultrasonography shows no hepatic artery flow at the portal hilum. B. Spectral Doppler ultrasonography of a parenchymal branch of the right hepatic artery shows a prolonged systolic acceleration time and decreased systolic amplitude, compatible with a tardus-parvus waveform. C. Grayscale ultrasonography shows a large thick-walled hypoechoic collection in the portal hilum (arrows). D. Coronal contrastenhanced computed tomography demonstrates a large, irregular, hypodense hepatic collection (arrows). The hepatic artery is thrombosed at the anastomosis (open arrow). The collection was drained, and it was consistent with an infected biloma. Catheter angiography (not shown) demonstrated no opacification/flow through the expected location of the hepatic artery, compatible with occlusion. Associated collateral hepatic parenchymal supply arising from hypertrophied branches of the right phrenic and right internal mammary arteries was found during catheter angiography.