Percutaneous transhepatic cholangiogram

Answer 1

Definition

A percutaneous transhepatic cholangiogram (PTCA) is an x-ray of the bile ducts inside and outside the liver. The x-ray is taken after contrast medium (dye) is injected directly into the bile ducts.

Alternative Names

PTCA; Cholangiogram - PTCA

How the test is performed

The test is performed in a radiology department by a radiologist. You will be asked to lie on your back on the x-ray table. The upper right side of your abdomen will be cleansed and you will be given a local anesthetic. A long, thin, flexible needle is then inserted through the skin into the liver.

With guidance from an x-ray machine that projects images onto a TV screen (fluoroscope), the bile duct is located and the contrast medium injected. The contrast medium then flows through the ducts and can be seen on the fluoroscopic monitor.

How to prepare for the test

Inform the health care provider if you are pregnant. You will be given a hospital gown to wear and will be asked to remove all jewelry.

How the test will feel

There will be a sting as the anesthetic is given and some discomfort as the needle is advanced into the liver. You may be given medication for sedation and/or pain control. Generally, the x-ray itself causes little or no discomfort.

Why the test is performed

Bile is a by-product of protein metabolism. It is created in the liver and removed from the body through the intestines via the bile ducts. It contains bilirubin, which is a product of normal metabolism. If bile cannot be removed from the body, bilirubin collects in the blood and is seen as a yellow discoloration of the skin and eyes (jaundice). One cause of this is a blockage of the bile ducts.

Also, the pancreas creates digestive fluids, which drain via a common bile duct into the intestine. A blockage can prevent the fluids from draining, and may cause pancreatitis (inflammation of the pancreas).

A PTCA test can help identify whether a blockage is causing the jaundice or pancreatitis.

Normal Values

The bile ducts are normal in size and appearance for the age of the patient.

What abnormal results mean

The results may show that the ducts are enlarged, which may indicate the ducts are blocked. The blockage may be caused by scarring or stones. It may also indicate cancer in the bile ducts, liver, pancreas, or region of the gallbladder.

See also:

• Blocked bile ducts
• Cholangitis(infection in common bile duct)

What the risks are

There is a slight chance of an allergic reaction to the contrast medium (iodine).

There is a slight chance of excessive blood loss, blood poisoning (sepsis), and inflammation of the bile ducts.

Special considerations

This test has been mostly replaced by an endoscopic retrograde cholangiopancreatography (ERCP) test. A PTCA may be done if an ERCP test cannot be performed or has failed.

A magnetic resonance cholangiopancreatography (MRCP) is a newer, noninvasive imaging method, based on MRI. It provides similar views of the bile ducts, but is not always possible to perform.

ReferencesAlfdahl NH. Diseases of the gall bladder and bile ducts. In: Goldman L, Ausiello D, eds.Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 159.

Answer 2

Definition

A percutaneous transhepatic cholangiogram (PTCA) is an x-ray of the bile ducts, the tubes that carry bile from the liver to the gallbladder and small intestine.

Alternative Names

PTCA; Cholangiogram - PTCA

How the test is performed

The test is performed in a radiology department by a radiologist.

You will be asked to lie on your back on the x-ray table. The health care provider will clean the upper right side of your belly area and then apply a numbing medicine.

X-rays are used to help the health care provider locate your liver and bile ducts. A long, thin, flexible needle is then inserted through the skin into the liver. The health care provider injects dye, called contrast medium, into the bile ducts. Contrast helps highlight certain areas they can be seen better. More x-rays are taken as the dye flows through the bile ducts into the small intestine. This can be seen on a nearby video monitor.

How to prepare for the test

Inform the health care provider if you are pregnant. You will be given a hospital gown to wear and will be asked to remove all jewelry.

You will be asked not to eat or drink anything for 6 hours prior to the exam.

Tell your health care provider if you are taking any blood thinners such as warfarin (coumadin) or Plavix (clopidrogrel).

How the test will feel

There will be a sting as the anesthetic is given and some discomfort as the needle is advanced into the liver. You may be given medication for sedation and/or pain control. Generally, the x-ray itself causes little or no discomfort.

Why the test is performed

This test can help diagnose the cause of a bile duct blockage.

Bile a liquid released by the liver. It contains cholesterol, bile salts, and waste products. Bile salts help your body break down (digest) fats. A blockage of the bile duct can lead to swelling of the gallbladder or pancreas.

This results of this test may help your doctor plan treatments for a bile duct blockage. For example, it can help determine where a drainage tube or stent can be placed.

Normal Values

The bile ducts are normal in size and appearance for the age of the patient.

What abnormal results mean

The results may show that the ducts are enlarged, which may indicate the ducts are blocked. The blockage may be caused by scarring or stones. It may also indicate cancer in the bile ducts, liver, pancreas, or region of the gallbladder.

See also:

• Blocked bile ducts
• Cholangitis(infection in common bile duct)

What the risks are

There is a slight chance of an allergic reaction to the contrast medium (iodine).

There is a slight chance of damage to nearby organs, excessive blood loss, blood poisoning (sepsis), and inflammation of the bile ducts.

Special considerations

This test has been mostly replaced by an endoscopic retrograde cholangiopancreatography (ERCP) test, which can also treat the blockage. This test may be done if an ERCP test cannot be performed or has failed.

A magnetic resonance cholangiopancreatography (MRCP) is a newer, noninvasive imaging method, based on MRI. It provides similar views of the bile ducts, but is not always possible to perform. It cannot be used to treat the blockage.

References

Lidofsky S. Jaundice. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 20.

Wael E.A. Saad, Michael J. Wallace, Joan C. Wojak, Sanjoy Kundu. Quality Improvement Guidelines for Percutaneous Transhepatic Cholangiography, Biliary Drainage, and Percutaneous Cholecystostomy. Journal of Vascular and Interventional Radiology Vol. 21, Issue 6, Pages June 2010. 789-795.

Reviewed By

Review Date: 01/31/2011

David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; Jason Levy, MD, Northside Radiology Associates, Atlanta, Georgia. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.