A 91-year-old man with a history of surgically cured nasal cancer and coronary artery disease presented to our emergency department (ED) due to epigastric discomfort and poor appetite lasting for 1 day. He denied any prior trauma, intra-abdominal surgery, or choledocholithiasis. There was no dizziness or exertional dyspnea, but icteric sclera was present. Laboratory testing revealed hyperbilirubinemia (3.67 mg/dl). An abdominal computed tomography (CT scan) showed one huge hepatic cystic lesion with biliary obstruction (Fig. 1a). The surgeon deemed surgical cystectomy or fenestration unsuitable owing to his advanced age and cardiac comorbidity. CT-guided pigtail insertion was done with bile-like fluid aspirated, but no bile duct connection was found. The diagnosis of biloma was favored. After 2 days of drainage, we instilled 70 ml povidone iodine solution into the cyst cavity for sclerotherapy. A non-contrast CT 1 week later showed significant shrinkage of the biloma (Fig. 1b). He was