[Sonographic diagnosis in cholestasis (author's transl)]

Area of Science:

• Medical Imaging
• Gastroenterology
• Diagnostic Radiology

Background:

• Cholestasis, characterized by impaired bile flow, requires accurate differentiation between intrahepatic and extrahepatic causes for effective management.
• Diagnostic imaging plays a crucial role in evaluating patients presenting with jaundice and signs of cholestasis.

Purpose of the Study:

• To compare the diagnostic accuracy of sonography with definitive diagnostic methods for cholestasis.
• To assess the capability of sonography in differentiating intrahepatic from extrahepatic cholestasis.
• To identify the limitations of sonography in diagnosing the etiology of bile flow disturbances.

Main Methods:

• A prospective study involving 156 patients with jaundice or clinical-chemical signs of cholestasis.
• Sonographic diagnosis was compared against final diagnoses established through endoscopic-retrograde cholangiography, percutaneous transhepatic cholangiography, surgery, or autopsy.

Main Results:

• Sonography successfully differentiated between intrahepatic and extrahepatic cholestasis in approximately 90% of cases.
• Limitations were noted in identifying prepapillary bile duct concrements (stones), present in 30% of patients.
• Sonography often did not provide etiological pointers for the underlying cause of bile flow disturbance.

Conclusions:

• Sonography is a highly effective tool for differentiating the location (intrahepatic vs. extrahepatic) of cholestasis.
• The identification of specific causes, particularly prepapillary bile duct stones, remains a limitation of sonography.
• Further investigations may be necessary for etiological diagnosis when sonographic findings are inconclusive.