Percutaneous transhepatic cholangiography: analysis of 120 cases

ABSTRACT

Percutaneous transhepatic cholangiography(PTC) is of value in differential diagnosis of cholestatic diseases. Authors had performed PTC in 120 patients with flexible needle of 23 gauge at the Department of Radiology, KangNam St, Mary's Hospital and Myung Dong St. Mary's Hospital during the period from Jan. 1976 to April 1980. PTC was accomplished successfully in 112 of 120 patients. Diagnoses included cholangiocarcinomas (27 cases), arcinomas ofpancreas head (21 cases), ampullary carcinomas (4 cases), metastatic carcinomas(4 cases), metastatic carcinomas (5cases), bile duct stones(27 cases), sclerosing cholangitis(6 cases), hepatitis(6 cases), liver cirrhosis(6 cases), post operative adhesions(5 cases), chronic pancreatitis(3 cases), stomach carcinomas(3 cases), clonorchiasis(2cases), blood clot (1 case), and remaining normal 4 cases. Some characteristic PTC findings were (1) segmentalannular narrowing and abrupt complete obstruction and polypoid filling defects of the bile duct incholangiocarcinoma, (2) typical nipple or rat-tail appearance of the distal commmon bile duct in pancreatic headcarcinoma, (3) single or multiple sharply and smoothly outlined filling defects whthin bile duct in all cases ofstones, (4) complete obstruction with shallow concavity in ampullary carcinoma, (5) diffuse or segmental narrowingof the intrahepatic bile duct and common bile duct in sclerosing cholangitis, (6) multiple tiny polypoid fillingdefects of gallbladder, common hepatic duct, and common bile duct in clonorchiasis, (7) normal appearance inhepatitis. The overall diagnostic accuracy of PTC in 66 operated cases was 89.4%, and complications following the examination were signficantly reduced by using a fine flexible needle(23 gauge). From the present study it is concluded as follows; 1. To evaluate obstructed or stenosed site accurately, aspiration of bile juice must bepreceded by a 23 gauge needle connected to either 10mo or 5ml syringe. 2. To diagose carcinoma of hte ampullaryportion, serial spot filmings were indispensible ot demonstrated modified appearance of obstructive lesions due tocontraction of Oddi sphincter. 3. In contrast to other reports, the most common site of cholangiocarcinomas wasthe common hepatic duct (12 of 27 cases) in our series. Rat-tail appearance was seen in both pancreatic headcarcinoma and carcinoma involving the distal end of the common bile duct. 4. PTC was a more valuable method for diagnosis of clonorchiasis.