RETROGRADE CHOLANGIOGRAPHY OF MALIGNANT BILIARY STRICTURES - SPECTRUMOF APPEARANCES AND PITFALLS

Purpose: To evaluate retrograde cholangiograms, explore the morphology of malignant biliary strictures, and determine if there are any featu res that may indicate a specific diagnosis. Materials and methods: The retrograde cholangiomas of 514 patients were reviewed. Cases with cli nical follow-up and subsequent studies indicating malignant involvemen t of the biliary tree were identified. Fifty patients were found. Resu lts: Carcinoma of the pancreatic head was the most common disease with 21 patients in this group. The morphology of the bile duct at the poi nt of involvement was nonspecific comprising shouldered intrinsic appe aring lesions as well as tapered in other cases. Pancreatic duct dilat ation was a relatively specific finding occurring in 80% of this group . Other malignancies to involve the bile ducts included cholangiocarci noma, metastases, ampullary carcinoma and gallbladder carcinoma. As wi th pancreatic carcinoma, the morphology of the lesion (e.g., shouldere d versus tapered, length of stricture, severity of proximal dilatation ) did not aid in the specific diagnosis of the pathology. Illustrative cases are presented where the morphology was unexpected for the event ual diagnosis (e.g., simulating intraluminal filling defects). Conclus ion: The cholangiographic appearance of a biliary stricture is usually not helpful in the specific diagnosis of the underlying etiology. Car cinoma of the pancreatic head may be suspected if pancreatic duct dila tation is also found. This article presents some unusual cholangiograp hic pitfalls that were identified, which initially distracted from the ultimate diagnosis.