Distal common bile duct obstruction: An experimental study in monkeys

Biliary obstruction was accomplished by surgically occluding the distal common bile duct in seven rhesus monkeys. Ultrasound scanning at 24-hour intervals showed that dilation of the common bile duct and gallbladder occurred before elevation of bilirubin or development of jaundice. The bile ducts expanded centrifugally from the obstructing point, with dilation of the intrahepatic ducts occurring several days after the onset of obstruction. After surgical release of the obstruction, the biliary ducts contracted centripetally, with the common bile duct requiring 30–50 days to return to normal size.     

Spontaneous disappearance of large stones from the common bile duct

Spontaneous disappearance of three large gallstones from the common bile duct is reported. One of the stones measured 15 mm in size and is the largest ever seen to pass into the intestine without perforation. The observation emphasizes the need for repeat diagnostic imaging of the biliary tract in patients who become free of symptoms before the intended operation.     

Carcinoid tumor of the bile duct: Case report

Carcinoid tumor of the bile duct is extremely rare. Ten cases have been reported in the literature. This report describes the eleventh case. A 55-year-old woman was hospitalized with biliary stenosis. Sonography (US) and computed tomography (CT) demonstrated a tumor in the upper common hepatic duct (CHD). Percutaneous transhepatic cholangiography showed extraluminal growth of the tumor. The tumor was resected and histologic examination showed carcinoid tumor of the common hepatic duct.     

Interhepatic duct: A new biliary anomaly

True accessory bile ducts occur in only 1% of patients. An accessory bile duct connecting the right and left hepatic ducts at the porta hepatis is described. This anomaly has never been reported previously, and was clinically significant in the presence of partial obstruction of an anomalous right hepatic duct by stones. The embryologic origin of this duct, which we term an interhepatic duct, is uncertain.     

Transcystic duct treatment of common bile duct stones

Successful removal of 2 retained common bile duct stones following cholecystostomy is described. With the use of the steerable catheter and the wire basket, one stone was crushed and the second was extracted in retrograde fashion through the cystic duct and gallbladder.     

Carcinoma of the ampulla of Vater: Sonographic and CT diagnosis

Twenty patients with carcinoma of the ampulla of Vater were studied with sonography (N = 9) or both sonography and CT (N = 11). The tumor was shown by sonography in 16 patients (80%) as a small, round or oval, fairly well delineated mass in between the dilated distal common bile duct and duodenum which was delineated owing to luminal fluid or gas (N = 13); or as a polypoid mass within the dilated distal common bile duct resulting in abrupt obstruction (N = 3). In the remaining four patients, the mass was not delineated. Bile ducts were dilated down to the level of mass or ampullary region in all cases (100%), while the pancreatic duct was dilated in five cases (45%). We believe that sonography is the technique of initial choice in the diagnosis of carcinoma of the ampulla of Vater by identifying the mass at the distal end of the dilated common bile duct and/or pancreatic duct.     

Calcified Klatskin tumor mimicking intrahepatic stone: case report

Calcification is a relatively uncommon manifestation of malignant liver neoplasm. Calcifications in peripheral cholangiocarcinomas but not in Klatskin tumor have been reported. We present a rare case of Klatskin tumor that had dystrophic calcification mimicking a intrahepatic stone in a 65-year-old man.     

Calcified Klatskin tumor mimicking intrahepatic stone: case report

Calcification is a relatively uncommon manifestation of malignant liver neoplasm. Calcifications in peripheral cholangiocarcinomas but not in Klatskin tumor have been reported. We present a rare case of Klatskin tumor that had dystrophic calcification mimicking a intrahepatic stone in a 65-year-old man.     

Pancreatic pseudocyst with fistula to the common bile duct: Radiological diagnosis and management

A patient was found to have fistulization of a pancreatic pseudocyst with the common bile duct. Resolution of the pseudocyst and the attendant biliary obstruction was achieved with percutaneous biliary drainage alone. The clinical and radiological features of this case are herein presented along with a brief review of the subject.     

MRCP显示胆管解剖变异2例报道

2007年1月-12月来我科行MRCP(磁共振胰胆管成像)检查患者共100例,其中发现肝胆管变异者2例,均在术前发现,占同期MRCP检查的2%。计胆囊管低位汇合入胆总管1例,副右肝管结石1例。现报道如下。患者1,女,40岁。以间歇性右中上腹疼痛十余年,加重7天为主诉收治入院。影像学检查:B超见胆总管下端强回声光团伴声影伴肝内外胆管扩张,诊断为胆总管下端结石伴胆管扩张。MRCP显示胆总管下段充盈缺损伴肝内外胆管明显扩张,胆道区域见一条异常管道汇入总胆管,其内见椭圆形充盈缺损,诊断为总胆管结石伴扩张,右副肝管变异伴结石(图1)。患者2,男,57岁。无明显诱因右上腹疼痛,呈持续性,以胆囊炎、胆囊结石收治入院。B超所见胆囊萎缩,胆囊壁增厚,胆囊内多个强回声光团伴声影,诊断为慢性胆囊炎,胆结石。MRCP检查见胆囊内多个充盈缺损影,胆囊壁毛糙,胆囊管较长,汇入至胆总管下端,诊断为胆结石,胆囊炎,胆道变异,胆囊管低位汇入于胆总管下端(图2)。2例病例均行剖腹手术,并在术中证实为右副肝管结石和胆囊管低位汇入。讨论胆道结石多见,大多手术治疗。临床上胆囊管先天变异较多,长胆囊管低位汇入者一般与肝总管平行走行,包括同一鞘膜内,如不...     

Villous adenoma of the common bile duct

A villous adenoma of the common bile duct (CBD) causing obstructive jaundice was demonstrated by sonography and ERCP in a 34-year-old man. The radiological and clinical features of this rare tumor are herein presented.     

Lymphoma in the wall of the bile ducts: Radiologic imaging

Extranodal lymphoma is not uncommon; however, lymphomatous involvement of the wall of the bile duct is rare, with only a few case reports available. Three cases were imaged with computed tomography (CT) and direct cholangiography at our institution. In one, Hodgkin disease recurred in the duct wall, producing a radiographic pattern indistinguishable from sclerosing cholangitis. In another, central sclerosis on cholangiography was associated with a separate liver mass identified by CT. This presentation of non-Hodgkin lymphoma mimicked cholangiocarcinoma. The third patient had multifocal, diffuse histiocytic lymphoma arising in the gallbladder and cystic duct, as well as in the kidneys and pancreas. Although the condition is unusual, the diagnosis of lymphoma in the bile duct wall should be considered, particularly when the cholangiographic picture of diffuse central sclerosis is associated with little or no observable mass on CT.     

Sonographic differentiation between the umbilical portion of the left portal vein and intrahepatic bile ducts

The method of differentiating between the portal vein and the bile ducts by means of their intrahepatic portions was studied. The left branch of the portal vein courses horizontally as the transverse portion, then veers anteriorly at an acute angle to make the umbilical portion. This characteristic form was demonstrated in all normal controls and 95% of the jaundiced patients studied. The left hepatic duct does not curve anteriorly at an acute angle, but branches off to the lateral segment running superior to the umbilical portion. This anatomic relationship and characteristic form of the umbilical portion were useful in differentiating the portal vein and the bile ducts.     

Intrahepatic bile duct dilatation secondary to hepatocellular carcinoma: CT features in 10 patients

Background: To determine the computed tomographic (CT) features of bile duct obstruction secondary to hepatocellular carcinoma (HCC). Methods: CT examinations of 10 patients (mean age, 58 years) with bile duct obstruction secondary to HCC were retrospectively reviewed. Results: All tumors were intrahepatic. Eight tumors were well-delineated and two were ill-defined. The largest diameters of tumor ranged from 1.5–6.0 cm (mean, 3.6 cm). All tumors were hypodense before contrast and did not contain calcification. After contrast, four tumors became hypodense, three were isodense, and three were hyperdense to the liver. No tumor demonstrated encapsulation. Diffuse intrahepatic bile duct dilatation was observed in seven patients. One patient had extrahepatic bile duct dilatation. Localized bile duct dilatation was observed in three patients, in the hemi-liver which contained the tumor. No tumor invaded the portal vein. Conclusion: Although rare, HCC should be included in the differential diagnosis of bile duct obstruction. This diagnosis should be suggested in patients with bile duct obstruction when CT shows an associated intra- or extrahepatic mass. Our results suggest that HCC responsible for bile duct obstruction is remarkable for the absence of encapsulation.     

胆总管阻塞的螺旋CT诊断

胆总管阻塞是临床多种疾病的总称,包括胆总管及其周围的肿瘤、结石、炎症或结核、寄生虫等.其影像学检查的目的主要是确定阻塞部位、明确阻塞原因、确定侵犯范围,为临床制订治疗方案提供依据.     

Carcinosarcoma of the extrahepatic bile ducts: cholangiographic and CT appearance

A case of histologically proven carcinosarcoma arising in the extrahepatic biliary tree is presented. The tumor appeared on cholangiography and computed tomography as a large expansile intraluminal mass causing biliary obstruction. Received: 19 May 1995/Accepted: 24 June 1995     

Diagnosis of intrahepatic and common duct stones: Combined unenhanced and contrast-enhanced helical CT in 1090 patients

Background We determined the accuracy of combined unenhanced and contrast-enhanced helical computed tomography (CT) for diagnosis of bile duct stones. Methods During a 12-month period, 1090 patients who underwent combined CT and endoscopic retrograde cholangiography (ERC) or percutaneous transhepatic cholangioscopy (PTC) were enrolled in this study. The results of prospective CT interpretation regarding the presence of bile duct stones were compared with results of endoscopic stone removal, PTC and with surgical results. In 70 patients, detectability of stones on CT was evaluated depending on stone types. Results Of 1090 study patients, 175 and 299 patients were confirmed to have intrahepatic and common duct stones, respectively. The sensitivity and specificity of combined CT were 73% and 98% for diagnosis of intrahepatic stones and 71% and 97% for common duct stones. Of 70 patients 24, 25, and 21 patients had cholesterol, black pigment, and brown pigment stones, respectively. Eleven of 24 cholesterol stones, 21 of 25 black pigment stones, and 15 of 21 brown pigment stones were detected on combined CT. Conclusion Combined CT is of limited sensitivity for detection of bile duct stones, especially in Western countries where cholesterol stones predominate. It may be of greater value in populations with a higher incidence of pigment stones. Other complementary imaging modalities are needed for patients with negative CT findings who are highly suspected to have biliary stones.     

Bile duct disease: Prospective comparison of ERCP,CT, and fat suppression MRI

The authors compared computed tomography (CT) and endoscopic retrograde cholangiopancreatography (ERCP), techniques commonly used to study the biliary tree, with pre- and post-Gd-DTPA breath-hold fast low angle shot (FLASH) and fat suppressed spin-echo in 28 consecutive patients with bile duct abnormalities detected on ERCP, including 11 patients with malignant disease and 17 patients with benign disease. ERCP, CT, and magnetic resonance (MR) images were prospectively interpreted in a blinded fashion and reviewed by consensus. ERCP characterized all cases of malignant disease by the presence of a narrowed bile duct lumen with irregular margins. CT and MRI detected all cases of malignant disease and characterized nine of 11 as malignant. In seven of these cases, CT and MRI showed thickening of extrahepatic bile duct walls >5 mm. MRI images showed intrahepatic-enhancing periportal tissue in four cases, which was not seen on CT images, and which was biopsyproven tumor extension. Benign disease was characterized on ERCP images by the demonstration of smooth tapered narrowings in 16 cases, whereas on CT and MR images it was characterized by mild to moderate dilatation of the intrahepatic bile ducts and wall thickness < 5 mm in 13 cases. Overall ERCP correctly characterized 27 cases as benign or malignant and CT and MRI both characterized 25. The results of this study show a trend that ERCP is superior to CT and MRI for characterizing bile duct disease.     

腹腔镜胆囊切除术胆管损伤12例临床分析

目的分析腹腔镜胆囊切除术(LC)胆管损伤的原因及其防治措施。方法回顾性分析1998年10月至2009年8月收治的12例LC致胆管损伤患者的临床资料。结果 7例行胆道修补和T管引流术;4例行Roux-en-Y吻合术;1例行胆管切开和T管引流术。无死亡病例。结论严格掌握手术适应证,强化操作训练,把握中转开腹的时机,可减少胆管损伤的发生。     

Transient intraluminal diverticulum of the esophagus: A significant flow artifact

Esophagography in 12 patients showed a characteristic oval-to oblong-shaped barium collection surrounded by a thin radiolucent margin. The collection closely resembled an intraluminal diverticulum. Twelve patients demonstrated these findings, 6 on single-contrast and 6 on double-contrast examinations. These findings were not reproducible on repeat barium swallows, and endoscopy failed to demonstrate an intraluminal diverticulum. Nine of the patients underwent esophagectomy and esophageal substitution. Pathologic examination of the gross specimen did not reveal evidence of intraluminal diverticula. The association of this radiologic appearance in patients with moderately severe motility disorder of the esophagus is emphasized.