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To the Editor.—
I disagree with some remarks in Dr. Harold D. Rosenbaum's article, "An Evaluation of Oral Cholecystography" (229:76, 1974). He is of the opinion that a roentgenogram of the abdomen before the administration of iopanoic acid may provide information that makes cholecystography unnecessary. However, x-ray visualization of calculi in the right upper quadrant along the liver edge does not always mean gallstones, even when they are faceted or otherwise "typical" of gallstones. Confirmation by cholecystography is necessary. This will avoid embarrassment in diagnosis.The following items, in my personal experience, proved, to the embarrassment of surgeons who did not use cholecystography for confirmation, that all apparent gallstones were in fact not biliary: faceted calculi in an obstructed renal pelvis; appendicoliths; clustered calculi in the head of the pancreas in a patient with marked scoliosis of the thoracolumbar junction; peripherally calcified encysted oil droplets in a patient in whom
Linsman JF. Oral Cholecystography. JAMA. 1974;229(11):1419. doi:10.1001/jama.1974.03230490021004
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