To the Editor.—
In "Cholestatic Jaundice in Adults: Algorithms for Diagnosis" (1981;245:1945), Fischer and co-workers quote: "The most difficult problem in the diagnosis of jaundice is the differentiation of intrahepatic from extrahepatic cholestasis." Indeed, with their algorithms for diagnosis it is absolutely correct.I am, however, astonished that so well prepared a study should not include a discussion of hepatobiliary imaging by radionuclide scintigraphy. Iminodiacetic acid and its congeners combined with technetium Tc 99m have been the subject of a number of articles for at least three years. The quality of the images has been uniformly satisfactory. Patients with more than 10 mg/dL of bilirubin have been described by Cheng et al.1Unless dealing with a postoperative patient with a T-tube in place, I should be tempted to place radionuclide evaluation at the top of the list of diagnostic procedures. Certainly before either endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous
DeR Kolisch P. Diagnosis of Cholestatic Jaundice. JAMA. 1981;246(24):2805. doi:10.1001/jama.1981.03320240015004
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