Serendipity in cholangiography

Seventeen of 107 consecutive direct cholangiography demonstrated serendipitous and unusual but significant contrast collections. The indications for and routes of cholangiography, correlative imaging procedures and outcome were retrospectively analysed. There was 6 bilomas, 3 aberrant bile ducts, 3 hepatic and 3 subphrenic abscesses and 2 gastrobiliary fistulae. Other contrast deposits were intra, perivascular, paraductal, interstitial and gastric reflux. While cholangiography cannot be proposed as the primary imaging modality in any of the above entities, the described incidental but significant cholangiographic features should be recognised, to optimize the total diagnostic yield (particularly in centres in developing economies, where cross-sectional imagers are scarce), redirect diagnostic endeavours to the real source of patients' problems, and discriminate normal and procedure-related from concurrent pathological accumulations, which may require specific therapy.