Biliary-hepatic vein fistula in a living donor liver candidate

IMAGING FINDINGS The biopsy was performed with an 18-gauge Biopense needle to obtain a core sample of liver, with one pass, and no complications were noted following the procedure. No histopathologic diagnosis was found on the liver biopsy. Imaging demonstrated a noncirrhotic liver, conventional hepatic arterial anatomy, trifurcation of intrahepatic bile ducts, fat quantification of 4.2% to 4.7%, and an adequate liver volume (Figure 1). She was deemed an appropriate living donor candidate and underwent an exploratory laparotomy, cholecystectomy, and intraoperative cholangiogram. The intraoperative cholangiogram demonstrated reflux of contrast from the right posterior hepatic duct into the adjacent liver parenchyma and subsequent appearance of the contrast in an adjacent peripheral right hepatic vein branch (Figure 2). A repeat cholangiogram demonstrated a similar finding, with slightly decreased flow of contrast into the right hepatic vein branch (Figure 3).