Clinical Evaluation, Ultrasound, Cholescintigraphy, and Endoscopic Retrograde Cholangiography in Cholestasis

Börsch, G; Wegener, Martin; Wedmann, B; M, Kissler; Glocke, M

doi:10.1097/00004836-198804000-00017

Cited by 17 publications

(8 citation statements)

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“…Specifically, US has been shown to be highly accurate (78–98%) for detecting extrahepatic obstruction 9 27 32 33 36 46 . In conjunction with a concordant clinical evaluation, US allows an accurate differentiation between liver parenchymal disease and extrahepatic obstruction (sensitivity 65%, specificity 92%, PPV 92%, NPV 98%) 8 47 . However, US is less discriminating with respect to the level and cause of obstruction, with reported accuracies ranging between 27–95% and 23–88%, respectively 29–32 34 35 46 48–50.…”

Section: Current Imaging Technologiesmentioning

confidence: 99%

“…Less common causes include benign strictures, chronic pancreatitis, metastatic nodes to the porta hepatis, and primary sclerosing cholangitis. Many studies have shown that clinical data such as history, physical examination, and laboratory tests can accurately identify up to 90% of patients whose jaundice is caused by extrahepatic obstruction 1–21. However, complete assessment of extrahepatic obstruction often requires the use of various imaging modalities to confirm the presence, level, and cause of obstruction, and to aid in treatment planning.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Nonoperative imaging techniques in suspected biliary tract obstruction

Tse

Barkun

Romagnuolo

et al. 2006

HPB

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Evaluation of suspected biliary tract obstruction is a common clinical problem. Clinical data such as history, physical examination, and laboratory tests can accurately identify up to 90% of patients whose jaundice is caused by extrahepatic obstruction. However, complete assessment of extrahepatic obstruction often requires the use of various imaging modalities to confirm the presence, level, and cause of obstruction, and to aid in treatment plan. In the present summary, the literature on competing technologies including endoscopic retrograde cholangiopancreatography (ERCP), percutaneous transhepatic cholangiopancreatography (PTC), endoscopic ultrasound (EUS), intraductal ultrasonography (IDUS), magnetic resonance cholangiopancreatography (MRCP), helical CT (hCT) and helical CT cholangiography (hCTC) with regards to diagnostic performance characteristics, technical success, safety, and cost-effectiveness is reviewed. Patients with obstructive jaundice secondary to choledocholithiasis or pancreaticobiliary malignancies are the primary focus of this review. Algorithms for the management of suspected obstructive jaundice are put forward based on current evidence. Published data suggest an increasing role for EUS and other noninvasive imaging techniques such as MRCP, and hCT following an initial transabdominal ultrasound in the assessment of patients with suspected biliary obstruction to select candidates for surgery or therapeutic ERCP. The management of patients with a suspected pancreaticobiliary condition ultimately is dependent on local expertise, availability, cost, and the multidisciplinary collaboration between radiologists, surgeons, and gastroenterologists.

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Section: Current Imaging Technologiesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Nonoperative imaging techniques in suspected biliary tract obstruction

Tse

Barkun

Romagnuolo

et al. 2006

HPB

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“…In two prospective studies, the sensitivity of ultrasonography for the detection of extrahepatic obstruction was 63 and 65 percent. 5,6 False negative results were most frequently associated with cases of early or partial obstruction due to a stone in the common bile duct and cases of primary sclerosing cholangitis in which the ducts could not dilate in response to obstruction. The degree of hyperbilirubinemia in this case argues against a partial obstruction, and there is no evidence of sclerosing cholangitis.…”

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confidence: 99%

Case 2-2000

Pratt¹,

Graeme‐Cook²

2000

N Engl J Med

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A 74-year-old man was admitted to the hospital because of recent, progressive jaundice.The patient had a long history of hypertension and type 2 diabetes mellitus, both of which were adequately controlled, and of peripheral atherosclerosis. A renal transplantation had been performed 10 years before the current admission because of end-stage diabetic nephropathy, and the patient continued to receive cyclosporine and azathioprine as maintenance therapy. In recent years, he had become confused, with failing memory.The patient resided in a nursing home. Four weeks before admission, progressive jaundice developed, with dark urine and light stools but without pain. Three days before admission, a crusted eruption appeared over his shins. He was brought to this hospital.The patient was retired from an occupation that involved no pertinent health hazards. His medications comprised cyclosporine, azathioprine (100 mg daily), atenolol, furosemide, nifedipine, and insulin.The temperature was 36.3°C, the pulse was 76, and the respirations were 18. The blood pressure was 145/70 mm Hg.On examination, the patient was deeply jaundiced and confused. A grade 2 systolic murmur was present at the cardiac apex. Abdominal examination revealed no evidence of ascites, organomegaly, a mass, or tenderness. There was peripheral edema (++), with multiple abrasions on both legs. Rectal examination showed no abnormalities; a stool specimen was minimally positive for occult blood. The results of a neurologic examination were normal.The urine was dark amber and was positive for bile (+++) and protein (+); the sediment contained no red cells, 0 to 2 white cells, and a few bacteria per high-power field. Laboratory tests were performed (Tables 1, 2, and 3). An electrocardiogram showed a normal rhythm with left-axis deviation, intraventricular block (QRS interval, 104 msec), and nonspecific ST-segment and T-wave abnormalities.Radiographs of the chest showed clear lungs and left ventricular enlargement; the aorta was tortuous and calcified. X-ray films of the legs showed diffuse vascular calcification. A computed tomographic (CT) scan of the pelvis (Fig. 1) and abdomen (Fig. 2), obtained without the intravenous administration of contrast material, revealed an atrophic right kidney, and a transplanted kidney in place of the native left kidney. There was slight fat stranding around the gallbladder on two adjacent images. Diffuse arterial calcification was present. The liver and pancreas appeared normal. An abdominal ultrasonographic study (Fig. 3) showed a partially decompressed gallbladder containing a single stone. The gallbladder wall was 4.5 mm thick. No pericholecystic fluid was found. The pancreas was obscured by overlying bowel gas. The spleen was normal. The renal transplant was 13 cm long; a Doppler study showed that the small intrarenal arteries had a normal resistive index. The portal venous system, hepatic veins, and hepatic artery were patent, with normal directions of flow.Urine cultures were negative. Treatment with azathioprine was disco...

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“…S onography has become the initial imaging test of choice in the differential diagnosis of cholestasis 1 because this modality can reliably detect dilatation of intrahepatic and extrahepatic bile ducts. [1][2][3] The presence of the intrahepatic "parallel channel sign" on gray-scale sonograms is usually believed to indicate dilatation of the intrahepatic bile ducts due to biliary obstruction. 4,5 In this situation, the appearance of 2 parallel lumina is caused by an enlarged bile duct that runs parallel to an intrahepatic branch of the portal vein.…”

mentioning

confidence: 99%

Color Doppler sonography avoids misinterpretation of the ?parallel channel sign? in the sonographic diagnosis of cholestasis

Herbay

Kühnel

Frieling

et al. 1999

J. Clin. Ultrasound

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Purpose The intrahepatic “parallel channel sign” on gray‐scale sonograms is generally interpreted as representing dilated bile ducts, but it may also be caused by enlargement of intrahepatic arteries. This study was performed to evaluate the incidence of misinterpretation of the parallel channel sign without color Doppler sonography and the characteristics of patients in whom misinterpretation of the parallel channel sign is likely to occur. Methods A total of 1,100 patients were examined by sonography. All patients with a parallel channel sign on gray‐scale sonograms underwent color Doppler sonography. In addition, laboratory values related to cholestasis were measured. Results The parallel channel sign was observed in 57 patients (5.2%). In 35 (61%) of these patients, color Doppler sonography revealed blood flow in both lumina, indicating that the parallel channel sign was not caused by enlarged bile ducts. Eighty‐six percent of this group had nonbiliary liver disease; the enlarged hepatic artery branches were associated with liver cirrhosis in 63% of this group. Color Doppler sonography confirmed that the other 22 patients (39%) had an enlarged intrahepatic bile duct. Conclusions Use of color Doppler sonography can help avoid misinterpretation of the parallel channel sign, especially in patients with nonbiliary liver disease. © 1999 John Wiley & Sons, Inc. J Clin Ultrasound 27:426–432, 1999.

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Clinical Evaluation, Ultrasound, Cholescintigraphy, and Endoscopic Retrograde Cholangiography in Cholestasis

Cited by 17 publications

References 0 publications

Nonoperative imaging techniques in suspected biliary tract obstruction

Nonoperative imaging techniques in suspected biliary tract obstruction

Case 2-2000

Color Doppler sonography avoids misinterpretation of the ?parallel channel sign? in the sonographic diagnosis of cholestasis

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