Case #10 Discussion:

DIAGNOSIS: Common duct biliary obstruction.

The beaded and dilated appearance of the intrahepatic bile ducts can be noted consistent with sclerosing cholangitis. The margins of the ducts are neither smooth nor narrow indicating the pathologic process. (Go To Image #1)

A 0.035 glide wire was used to cannulate the common duct through the obstruction. This wire was passed beyond the obstruction to the distal biliary tree and ultimately the GI tract. A 12.5 French APDL catheter was passed over this wire to keep the biliary tree patent. (Go To Image #2)

The patient's other diagnostic possibilities included a HIDA scan or an ERCP. The advantage of PTC is that the therapeutic procedure or passing a catheter through the obstructed bile duct can be performed with the diagnostic examination. The patient can then pass bile through her APDL into the GI tract to alleviate her jaundice.

This patient also had a core liver biopsy performed to evaluate for cirrhosis.