Diagnostic problems in diseases of the biliary tract continue. In some patients operation for stone or tumor in the common duct reveals cirrhosis or hepatitis. Other patients with commonduct stones may be observed for long periods with a clinical impression of parenchymal liver disease.
Percutaneous cholangiography, a procedure performed with local anesthesia, provides remarkable delineation of the biliary tree when successful. A number 19- or 20-gauge needle, 6 inches in length, is inserted through the skin of the anterior abdominal wall into the substances of the liver. The site of puncture is usually in the midclavicular line just below the right costal margin. Use of the fluoroscope with the image intensifier facilitates the procedure. When bile is obtained from the needle, a contrast agent is injected and the filling of the bile ducts is observed. Roentgenograms may be taken at appropriate times during the injection.
The procedure is most useful
PERCUTANEOUS CHOLANGIOGRAPHY. JAMA. 1965;194(4):451. doi:10.1001/jama.1965.03090170129024