Spontaneous perforation of the biliary duct is a rare disease that must be treated immediately when diagnosed in infancy. This disease must be suspected in a previously healthy infant who suddenly has abdominal distension, ascites, and intermittent jaundice. The best way to diagnose the leakage of bile in a clinically stable infant is to use radionuclide hepatobiliary scan. In most cases, however, the diagnosis of the perforation of common bile duct is frequently made during the procedure of operative cholangiogram. The prognosis is usually good with early diagnosis. We experienced an infant of 4 months of age who presented with sudden abdominal distension, jaundice and acholic stool, and confirmed the diagnosis of perforation of common bile duct through operative cholangiogram with t-tube insertion. We report a case of spontaneous perforation in an infant with review of the literatures.
Ascites ; Bile ; Bile Ducts ; Common Bile Duct* ; Diagnosis ; Early Diagnosis ; Humans ; Infant* ; Jaundice ; Prognosis ; Rare Diseases

Gallstone pancreatitis is caused by migration of gallstones through the common bile duct and ampulla of Vater, where ohetruction or impaction may occur. Early detection and endoscopic treatment of impacted gallstones are very important for the amelieration of pancreatitis. Pancreatic imagings, such as conventional ultrasonography, computerised tomography(CT) and endoscopic retrograde cholangiypancreatography(ERCP) have beea used for the diagnosis of gallstone pancreatitis. But these imaging net are often unsatisfactory fordetection of the impacted gallstones in the common bile duct ampulla of Vater. Especially ERCP has been contraindicated in acute pancreatitis. Endoscopic ultrasonography(EUS), which was recently developed, has been known as highly accurate diagnostic tool in the diagnosis of biliary and pancreatic disease. The high resolution of EUS is capable of showing unique morphological detail in gallstone pancreatitis. We report 3 cases of gallstone pancreatitis which Was accurately diagnosed by EUS and successfully treated by endoscopic treatment.
Ampulla of Vater ; Cholangiopancreatography, Endoscopic Retrograde ; Common Bile Duct ; Diagnosis ; Endosonography* ; Gallstones* ; Pancreatic Diseases ; Pancreatitis* ; Ultrasonography

To investigate the diagnostic accuracy of ERCP in pancreatobiliary disease, the authors analysed the 1,244 cases of ERCP. The success rate of ERCP was 91.5%. The diagnostic accuracy of ERCP was 93.6% and complications occurred in 2.1%. Complications included pancreatitis,cholangitis and drug reactions. Among the biliary tract disease diagnosed, by ERCP, biliary tract stone was the most common finding. Compared with operative diagnosis of biliary tract stones,the sensitivity of ERCP diagnosis was 92.7% while that of sonographic diagnosis was 81.4%. The specificity of ERCP diagnosis was 94.4% while that of sonagraphic diagnosis was 80.9%. ln the diagnosis of common bile duct stones, ERCP was more accurrate than sonographic diagnosis. The results show that ERCP was a safe and effective diagnostic tool in the assessment of pancreatobiliary tract disease.
Biliary Tract ; Biliary Tract Diseases ; Cholangiopancreatography, Endoscopic Retrograde* ; Common Bile Duct ; Diagnosis ; Sensitivity and Specificity ; Ultrasonography

To investigate the diagnostic accuracy of ERCP in pancreatobiliary disease, the authors analysed the 1,244 cases of ERCP. The success rate of ERCP was 91.5%. The diagnostic accuracy of ERCP was 93.6% and complications occurred in 2.1%. Complications included pancreatitis,cholangitis and drug reactions. Among the biliary tract disease diagnosed, by ERCP, biliary tract stone was the most common finding. Compared with operative diagnosis of biliary tract stones,the sensitivity of ERCP diagnosis was 92.7% while that of sonographic diagnosis was 81.4%. The specificity of ERCP diagnosis was 94.4% while that of sonagraphic diagnosis was 80.9%. ln the diagnosis of common bile duct stones, ERCP was more accurrate than sonographic diagnosis. The results show that ERCP was a safe and effective diagnostic tool in the assessment of pancreatobiliary tract disease.
Biliary Tract ; Biliary Tract Diseases ; Cholangiopancreatography, Endoscopic Retrograde* ; Common Bile Duct ; Diagnosis ; Sensitivity and Specificity ; Ultrasonography

The Mirizzi syndrome is a rare benign cause of obstructive jaundice. It is particularly interesting to surgeons because the surgery has to be carefully planned to avoid unnecessary damage to the common bile duct. Furthermore, it gives a differential diagnosis dilemma for surgeons as well as radiologist because there are no diagnostic procedures or clinical features that have a perfect access. As a result, the Mirizzi syndrome often has been mistaken for gallbladder cancer and cholangiocarcinoma. We experienced of a 76-year-old male patient, whose clinical symptoms were jaundice, epigastric pain and fever with chill and misdiagnosed as a cholangiocarcinoma with liver metastasis.
Aged ; Bile Duct Diseases ; Cholangiocarcinoma* ; Cholelithiasis ; Cholestasis ; Common Bile Duct ; Cystic Duct ; Diagnosis, Differential ; Fever ; Gallbladder Neoplasms ; Humans ; Jaundice ; Jaundice, Obstructive ; Liver ; Male ; Mirizzi Syndrome* ; Neoplasm Metastasis

PURPOSE: To describe the radiologic features of computed tomography(CT) in hepatocelluar carcinoma(HCC) with bile duct involvement. MATERIALS AND METHODS: We retrospectively analyzed the two phase spiral CT findings of 31 patients in whom HCC with bile duct invasion (n=28) or compression (n=3), was diagnosed. Eight of these underwent follow-up CT after transarterial chemoembolization. We analyzed the size, type, location, enhancement pattern, and lipiodol retention of parenchymal and intraductal masses, as well as their and lymphadenopathy. RESULTS: In all patients with bile duct invasion, single or multiple masses were demonstrated in the bile ducts. Intraductal masses showed the same enhancement characteristics as the parenchymal mass (kappa 0.550, p < .001), and were contiguous to this mass. In 14 of 28 patients, intraductal masses filled the peripheral intrahepatic bile ducts and extended to the common bile ducts. In the other 14, the parenchymal mass extended to the area of the porta hepatis and then directly invaded the large ducts. In nine of the 28 patients, there was a hypoattenuated cleft between the intraductal mass and ductal wall. In six, a parenchymal mass was not apparent (n = 2), or was smaller than 2cm (n = 4). In five of eight patients (62.5%), follow-up CT after transarterial chemoembolization showed compact or partial lipiodol retention within the intraductal mass. In patients with bile duct compression, perihilar lymph nodes were noted along with the dilated intrahepatic duct but no intraductal mass was demonstrated in the duct. CONCLUSION: Hepatocellular carcinomas cause bile duct dilatation either by direct invasion or by extrinsic compression of the bile duct with surrounding enlarged nodes. For the diagnosis of this condition, CT is helpful.
Bile Ducts* ; Bile Ducts, Intrahepatic ; Bile* ; Carcinoma, Hepatocellular* ; Common Bile Duct ; Diagnosis ; Dilatation ; Ethiodized Oil ; Follow-Up Studies ; Humans ; Lymph Nodes ; Lymphatic Diseases ; Retrospective Studies ; Tomography, Spiral Computed

We describe the imaging features of two cases of biliary ascariasis. Ultrasonography and CT showed no specific abnormal findings, but MR cholangiography clearly demonstrated an intraductal linear filling defect that led to the correct diagnosis. MR cholangiography is thus a useful technique for the diagnosis of biliary ascariasis.
Adult ; Animal ; Ascariasis/*diagnosis ; *Ascaris lumbricoides ; *Bile Ducts, Intrahepatic ; Biliary Tract Diseases/*diagnosis/*parasitology ; Common Bile Duct Diseases/*diagnosis/*parasitology ; Female ; Human ; *Magnetic Resonance Imaging

PURPOSE: To evaluate value of superparamagnetic iron oxide (SPIO) as a negative oral contrast agent in MR cholangiopancreatography (MRCP). MATERIALS AND METHODS: Forty-eight patients with suspected biliary tract or pancreatic diseases and six healthy volunteers were enrolled in this study. All MR images were obtained using a 1.5 T MR unit. MRCP using fat-suppressed half-Fourier acquisition single-shot turbo spin echo (HASTE) and turbo spin echo (TSE) techniques were performed and reconstructed with maximal intensity projection (MIP). To determine the most optimal concentration of SPIO to obliterate the high signal intensity of water, a phantom experiment was conducted with various concentrations of SPIO-water mixture. Two radiologists evaluated pre- and postcontrast MRCPs. The contrast enhancement was assessed on the basis of loss of signal intensity in the stomach and duodenum. RESULTS: In the phantom experiment, a significant increase of percentage of signal intensity loss (PSIL) occurred in concentration of 22.4 ugFe/ml (Feridex 1 ml diluted with water 500 ml). Postcontrast MRCP showed an improved image quality compared with precontrast images. The rate of improvement in the diagnosis of diseases of the common bile duct and pancreatic duct was 25% (12/48). CONCLUSION: In patients with suspected biliary tract and pancreatic diseases, the SPIO is useful as a negative oral contrast agent for MRCP and provides an improvement of image quality.
Biliary Tract ; Common Bile Duct ; Diagnosis ; Duodenum ; Healthy Volunteers ; Humans ; Iron* ; Pancreatic Diseases ; Pancreatic Ducts ; Stomach ; Water

Although ultrasonography replaced many invasive studies in biliary tract diseases, direct cholangiography does still play an important role in the diagnosis and management of choledocholithiasis. Endoscopoic retrograde cholangiography (ERC) is regarded as the best method in evaluation of exact extent of the disease and its frequent complication, cholangitis. Authors analysed 56 cases of choledocolithiasis diagnosed by ERC and compared these with ERC in 18 cases of normal, 22 cases of cholecystitis, 15 cases of clonorchiasis and 9 cases of parenchymal diseases of liver. The results are as follows; 1. ERC findings of choledocholithiasis are filling defects by stoneor stones, dilation of common hepatic as well as common bile ducts and findings of cholangitis. 2. ERC findings of cholangitis are dilatation of larger intrahepatic biliary radicles and acute peripheral tapering, decrease of arborization, increased or right angle branching pattern, straightening and rigidity as well as irregular narrowing of intrahepatic biliary trees. This findings are observed in majority of choledocholithiasis. 3. Over9mm in diameter at intraprancreatic portion of common bile duct was regarded as abnormal, with 95% sensitivity,85% specificity and 91% diagnostic accuracy by decision matrix analysis. 4. In the presence of dilatation of CBD and findings of cholangitis in ERC, one should consider choledocholithiasis in spite of absence of stone defect.
Biliary Tract Diseases ; Cholangiography ; Cholangitis ; Cholecystitis ; Choledocholithiasis ; Clonorchiasis ; Common Bile Duct ; Diagnosis ; Dilatation ; Liver ; Methods ; Sensitivity and Specificity ; Trees ; Ultrasonography

We have reported a case of Mirizzi syndrome preoperatively diagnosed using MR cholangiopancreatography. MRCP and T2-weighted image using a single-shot fast spin-echo sequence accurately depicted all components of Mirizzi syndrome, including impacted stone in the neck of the gallbladder compressing the common hepatic duct and wall-thickening of the gallbladder without any evidence of malignancy. The combination of MRCP and T2-weighted image can be counted on to replace conventional modalities of diagnosing Mirizzi syndrome without any loss of diagnostic accuracy.
Bile Duct Diseases/etiology* ; Bile Duct Diseases/diagnosis ; Case Report ; Cholangiopancreatography, Endoscopic Retrograde ; Cholelithiasis/diagnosis ; Cholelithiasis/complications* ; Constriction, Pathologic/etiology ; Gallbladder/pathology ; Hepatic Duct, Common* ; Human ; Magnetic Resonance Imaging* ; Male ; Middle Age ; Syndrome