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Intravenous Cholangiography in the Presence of Iaundice

Intravenous Cholangiography in the Presence of Iaundice Intravenous Cholangiography in the Presence of Iaundice 1 David Rosenblum , M.D. and Solomon Schwartz , M.D. Jewish Hospital of Brooklyn 555 Prospect Place Brooklyn 38, K. Y. Excerpt Cholografin 20 per cent (sodium N,N'-adipylbis (:3-amino-2,4,o,-triiodo) benzoate, Squibb) is of inestimable value in demonstrating the common du ct of the cholecystectomized patient. That it is useful also in the presence of jaundice is not so well known. Published accounts of visualizat ion of the ducts of jaundiced patients are few in number. Hastings-James and Glazebrook (1) report successful visualization in 1 of 2 cases. The degree of jaundice is not stated. Aldridge (2) was successful in 6 of 15 cases. His criteria for selection of patients were perhaps less rigid than those adopted by us, in that he included in his series patients who had been jaundiced within one week of the examination. Because the icterus index appears an unreliable criterion, we have used a serum bilirubin of 1.0 and above (normal in our laboratory 0.8) as indicative of jaundice. To date, we have attempted intravenous cholangiography with Cholografin in 26 jaundiced patients and have succeeded in visualizing the common duct in 5 (Figs. 1–5), or 19 per cent. Actually, in 1 case, the examination was not completed because of severe nausea and vomiting. If this case is discounted, the percentage of successful visualization rises to 20 per cent. In 2 cases the common duct was not visualized initially but was demonstrated later. In the first of these, failure occurred with an icterus index of 15 and a serum bilirubin of 1.8. Successful cholangiography was performed when these values had fallen to 10 and 0.9, respectively. In the second case, initial values were 16 and 1.8 but had decrease d to 8 and 0.8 several days after cholangiography. No values were available for the date on which the examination was performed. Neither of these cases is included as a successful visualization In the presence of jaundice. The highest icterus index at the time of visualization was 22 and the highest serum bilirubin: 3.3. Whenever serial serum studies are available, they appear to indicate that jaundice was on the wane at the time of visualization of the common duct. The highest values given occurred in a case in which, five days later, the icterus index and serum bilirubin had fallen to 8 and 1.3, respectively. Average values at the time of visualizat ion were 12 for t he icterus index and 1.7 for serum bilirubin. Serum bilirubin values are available in 20 of the 21 failures. At the time of cholangiography in these cases, jaundice was waning in 9, static in 5, and increasing in 6. In only 1 case with waning jaundice were the values below the averages given for adequate visualization. In this instance success was subsequently obtained, but the case was counted among the failures because exact values at the time of examination were not known. In all other failures, serum values at the time of examination were higher than the averages for successful visualization. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Radiology Radiological Society of North America, Inc.

Intravenous Cholangiography in the Presence of Iaundice

David Rosenblum; Solomon Schwartz
Radiology , Volume 67 (2): 247 – Aug 1, 1956
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References (1)

Publisher
Radiological Society of North America, Inc.
Copyright
Copyright © 1956 by Radiological Society of North America
ISSN
1527-1315
eISSN
0033-8419
DOI
10.1148/67.2.247
pmid
13350523
Publisher site
See Article on Publisher Site

Abstract

Intravenous Cholangiography in the Presence of Iaundice 1 David Rosenblum , M.D. and Solomon Schwartz , M.D. Jewish Hospital of Brooklyn 555 Prospect Place Brooklyn 38, K. Y. Excerpt Cholografin 20 per cent (sodium N,N'-adipylbis (:3-amino-2,4,o,-triiodo) benzoate, Squibb) is of inestimable value in demonstrating the common du ct of the cholecystectomized patient. That it is useful also in the presence of jaundice is not so well known. Published accounts of visualizat ion of the ducts of jaundiced patients are few in number. Hastings-James and Glazebrook (1) report successful visualization in 1 of 2 cases. The degree of jaundice is not stated. Aldridge (2) was successful in 6 of 15 cases. His criteria for selection of patients were perhaps less rigid than those adopted by us, in that he included in his series patients who had been jaundiced within one week of the examination. Because the icterus index appears an unreliable criterion, we have used a serum bilirubin of 1.0 and above (normal in our laboratory 0.8) as indicative of jaundice. To date, we have attempted intravenous cholangiography with Cholografin in 26 jaundiced patients and have succeeded in visualizing the common duct in 5 (Figs. 1–5), or 19 per cent. Actually, in 1 case, the examination was not completed because of severe nausea and vomiting. If this case is discounted, the percentage of successful visualization rises to 20 per cent. In 2 cases the common duct was not visualized initially but was demonstrated later. In the first of these, failure occurred with an icterus index of 15 and a serum bilirubin of 1.8. Successful cholangiography was performed when these values had fallen to 10 and 0.9, respectively. In the second case, initial values were 16 and 1.8 but had decrease d to 8 and 0.8 several days after cholangiography. No values were available for the date on which the examination was performed. Neither of these cases is included as a successful visualization In the presence of jaundice. The highest icterus index at the time of visualization was 22 and the highest serum bilirubin: 3.3. Whenever serial serum studies are available, they appear to indicate that jaundice was on the wane at the time of visualization of the common duct. The highest values given occurred in a case in which, five days later, the icterus index and serum bilirubin had fallen to 8 and 1.3, respectively. Average values at the time of visualizat ion were 12 for t he icterus index and 1.7 for serum bilirubin. Serum bilirubin values are available in 20 of the 21 failures. At the time of cholangiography in these cases, jaundice was waning in 9, static in 5, and increasing in 6. In only 1 case with waning jaundice were the values below the averages given for adequate visualization. In this instance success was subsequently obtained, but the case was counted among the failures because exact values at the time of examination were not known. In all other failures, serum values at the time of examination were higher than the averages for successful visualization.

Journal

Radiology – Radiological Society of North America, Inc.

Published: Aug 1, 1956

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