Fig. 5.

Biliary necrosis as a manifestation of ischemic cholangiopathy in a 75-year-old man with pancreatic adenocarcinoma and hepatic arterial and portal venous thrombosis. Axial contrast-enhanced CT images at three levels A–C show multiple collections in the liver which have a peribiliary distribution and several of which contain gas (arrows), indicative of communication with the biliary tree in this patient with an indwelling common bile duct stent. The collection in the left lateral section is ruptured, resulting in bilious ascites (asterisk, B). There is occlusion of the main portal vein and common hepatic artery at the site of the hypoenhancing pancreatic head mass (thick arrow, C). Rather than representing ischemic injury to the central ducts, biliary necrosis represents ischemic necrosis of the peripheral branch bile ducts