Diagnostic imaging to identify the cause of jaundice

Imaging studies can be helpful in identifying the etiology of conjugated (direct) hyper-bilirubinemia. An elevated direct bilirubin level suggests obstructive jaundice, and ultrasound or computed tomographic (CT) imaging may identify the responsible structural lesion. Imaging can also be used to guide percutaneous biopsy. A cost-effective strategy for determining the cause of direct hyperbilirubinemia rests on ultrasound as the primary modality. Endoscopic retrograde cholangiopancreatography and CT are performed as follow-up studies only when necessary. Magnetic resonance imaging is rarely useful.