Figure 11b. Sloughing of biliary epithelium in a liver transplant recipient with known hepatic artery thrombosis and biliary necrosis. (a) Transverse US image shows distention of the common bile duct by echogenic intraluminal material (arrows), which represents sloughed biliary epithelium. (b) Coronal MR image of the porta hepatis, obtained after administration of a biliary excreting agent, shows a filling defect within the biliary tree confluence (arrows), which represents the sloughed epithelium. (c) Contrast-enhanced CT image shows the "cutoff" of the main hepatic artery (large arrow). Short arrows = surgical sutures of the hepatic artery anastomosis. (d) Color Doppler image obtained at the porta hepatis shows no flow in the hepatic artery. Only portal vein flow is seen (red areas). (Fig 11b courtesy of K. Khalili, MD, Princess Margaret Hospital, Toronto, Ontario, Canada.)