Biliary dilatation: defining the level and cause by real-time US

In a 15-month period, 110 patients with subsequently proved biliary dilatation were evaluated with ultrasound (US). The level of dilatation was defined as pancreatic, suprapancreatic, or at the level of the porta hepatis. Causes of dilatation included pancreatitis, choledocholithiasis, neoplasm, and stricture. The distal duct was examined initially on transverse scans obtained with the patient in a semierect right posterior oblique position; the proximal duct was then examined on longitudinal scans obtained with the patient in a supine left posterior oblique position. When this scanning technique was used, US indicated the level of dilatation in 91.8% of cases and suggested the correct cause in 70.9%. Because this approach markedly improves US visualization of the intrapancreatic bile duct, distal obstructing lesions, which are the most common, can be optimally examined.