Limitations of ultrasonography in evaluating patients with jaundice or cholecystectomy

Abdominal ultrasonography has been shown to accurately distinguish medical (nonobstructive) jaundice from surgical (obstructive) jaundice. As occurs commonly with a new diagnostic procedure, initial evaluations are enthusiastic and emphasize the positive features of the technic. When further experience with the procedure is acquired, its negative features are recognised and reported. We review our experience and that of others to stress the limitations of ultrasonography and the potential for misinterpretation of its findings when evaluating the biliary tract in patients with jaundice or postcholecystectomy biliary colic. The applications of computed tomography and cholescintigraphy are briefly and critically evaluated in this same patient population. The role of sonography as a screening procedure and the findings that indicate the need to proceed to other imaging technics are examined. Finally, we describe our criteria for choosing the next step in the diagnostic evaluation--intravenous, percutaneous transhepatic, or endoscopic retrograde cholangiography.