Role of radiology in pancreatic disorders

To find out mode of presentation and role of image modalities in pancreatic lesions in patients referred to radiology department. Prospective study. Radiology departments of CMH Muzaffarabad and CMH Sialkot from Jan 2003 to Jan 2006. This study was conducted at CMH Muzaffarabad in collaboration with Kashmir CT Scan installed at CMH Muzaffarabad and CMH Sialkot in collaboration with PVT-CT Scans. Radiology departments of CMH Muzaffarabad and CMH Sialkot are equipped with ultrasound and fluoroscopic facilities. We evaluated 50 patients of different pancreatic lesions referred to our radiology department. Pancreatic lesions were more common in men [70%] than women [30%]. Large group of patients [90%] belong to old age group. Out of 50 cases, 60% patients presented with jaundice, 20% with acute abdomen, 10% with mass abdomen and 10% with mixed symptoms. Ultrasonograph [USG] has been the main imaging modality in our study. All patients initially scanned with USG, patients diagnosed as mass pancreas on USG were advised CT scan, percutaneous transhepatic cholangiogram [PTC]/endoscopic retrograde cholangiopancreatogram [ERCP], and USG guided FNAC. In 15 [30%] cases ultrasound was inconclusive, in 10 patients pancreas was not clearly visualized and in 05 cases pancreas was normal looking. CT scan is more sensitive in picking up pancreatic lesions. CT scan was done in 24 [48%] patients. The results are shows in table. In our study 26 [52%] patients were of pancreatitis [Acute/chronic] and 20 [40%] of growth pancreas, 04 [8%] misc. cases [Divisum pancreas 02, annular pancreas 01, retropancreatic haemangioma 01]. It is concluded that pancreatic lesions present as acute abdomen, mass epigastrium and jaundice. In our set up USG is the main imaging modality to diagnose the pancreatic lesions. CT scan, PTC and ultrasound guided FNAC used as complementary tool

Per-cutaneous transhepatic cholangiography in obstructive jaundice by using lumbar puncture needle

To assess the effectiveness of per-cutaneous transhepatic cholangiography [PTC] with 22G lumbar puncture [LP] needle in obstructive Jaundice. The study was carried out at CMH Muzaffarabad and CMH Sialkot from January 2003 to March 2006. Twenty two patients were included in our study who underwent PTC for evaluation of obstructive Jaundice. PTC was done in these patients using ordinary LP needles [22 G] instead of Chiba needle under fluoroscopic guidance. Preliminary ultrasound scan and coagulation profile were done in all patients. Of 22 patients 12 were males, and 10 females, their mean age being 55+ 10 years. Intra hepatic and extra hepatic channels were opacified with 100% accuracy. Growth / masses and stones were commonest causes of obstructive jaundice. Out of growth and masses, cholangiocarcinomas [including Klatskin tumor] and carcinoma head of pancreas were more common. PTC related complications were nil. PTC can be successfully performed in cases of obstructive jaundice with ordinary LP needle [22 G]. This is cost effective, simple and less time consuming