Confirmation of a Biliothoracic Fistula With Dynamic [ 68 Ga]Ga-TEoS-DAZA-PET/CT.

Accurate localization of biliary leaks with conventional imaging remains challenging. We report a critically ill patient with a suspected biliothoracic fistula following a perforated gastric ulcer repair. Dynamic hepatobiliary PET/CT using the tracer [ 68 Ga]Ga-TEoS-DAZA enabled antegrade, high-temporal-resolution visualization of bile flow, directly demonstrating bile leakage into a drained abscess cavity with cranial extension into the thorax. Compared with scintigraphy and MRI, hepatobiliary PET offers superior dynamic tomographic imaging, robustness against motion artifacts, and precise leak localization, highlighting its potential value in complex biliary complications.