2019 Volume 33 Issue 4 Pages 726-733
An 81-year-old man with primary sclerosing cholangitis underwent PTBD because of intractable biliary stenosis. After PTBD, he developed a fever and his blood culture was positive. CT showed a pulmonary artery embolus and nodules with cavities in the peripheral lung area (feeding vessel sign). He was diagnosed with septic pulmonary embolism (SPE). CT also showed the PTBD tube contacted with the hepatic vein and there was a septic thrombus extending from that area. Venous bleeding was found on exchange of the PTBD tube, which was stopped with compression by the tube.
From these findings, we believe the SPE was an indirect result of an injury to the hepatic vein during PTBD which caused a biliary vascular fistula leading to a migration of a septic thrombus from the hepatic vein to the inferior vena cava.
SPE should be suspected if CT shows a feeding vessel sign after PTBD. SPE can be produced even with peripheral hepatic vein trauma. SPE due to PTBD is a rare but important complication after PTBD.
