Bile Plug Syndrome

  • Etiology:
    — Inspissated bile obstructs the extrahepatic biliary tree
    — Can be due to cystic fibrosis, hepatocellular damage, total parenteral nutrition, erythroblastic jaundice
  • Imaging:
    — Sludge in gallbladder or bile ducts visualized as large filling defects in the biliary tree leading to biliary obstruction
    — Gallbladder wall thickening
  • DDX: Cholelithiasis
  • Complications:
  • Treatment: Biliary lavage via percutaneous cholangiogram can be used to flush the inspissated bile out of the biliary tree
  • Clinical: Hyperbilirubinemia

Radiology Cases of Bile Plug Syndrome

Percutaneous cholangiogram of bile plug syndrome
AP image from a percutaneous cholangiogram shows a dilated intrahepatic biliary tree and a markedly dilated extrahepatic biliary tree containing large filling defects within it. In this case the cholangiogram was therapeutic as well as diagnostic.