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Segmental biliary obstruction: false-negative diagnosis with direct cholangiography without US guidance
Radiology
|July 1, 1987
Summary
Segmental intrahepatic ductal obstruction from calculi can cause acute cholangitis, often missed by standard cholangiography. Ultrasound-guided percutaneous transhepatic cholangiography (PTC) aids diagnosis and treatment.
Area of Science:
- Radiology
- Gastroenterology
- Hepatology
Background:
- Segmental intrahepatic biliary obstruction with calculi is a cause of acute cholangitis.
- Routine cholangiography may fail to detect this condition.
Observation:
- Ultrasonography (US) and computed tomography can reveal intrahepatic ductal dilatation and calculi.
- US can guide percutaneous transhepatic cholangiography (PTC).
Findings:
- US-guided PTC confirmed acute cholangitis due to segmental biliary obstruction and intrahepatic calculi in four cases.
- Initial blind cholangiography missed the diagnosis in two cases.
Implications:
- US-guided PTC is crucial for diagnosing and managing acute cholangitis secondary to segmental biliary obstruction.
- This technique improves diagnostic accuracy over blind cholangiography.