Diagnostic pitfalls in the cholangiographic diagnosis of choledochoceles: cholangiographic quality and its effect on visualization

Background: We wanted to establish reasonable cholangiographic diagnostic c riteria by determining the sensitivity of cholangiography in detecting chol edochoceles and those factors that could compromise visualization of choled ochoceles. Methods: Over 4 years, 21 patients (seven male, 14 female; mean age = 67 ye ars) were confirmed as having choledochoceles on endoscopic retrograde chol angiopancreatography (ERCP). Cholangiographic diagnosis was made by followi ng three criteria: a radiolucent halo around the distal common bile duct (C BD), bulbous dilatation of the distal CBD, and the presence of sequential m orphologic changes on serial cholangiography. Any two or more combinations of these three criteria were considered enough to diagnose a choledochocele on cholangiography. We compared cholangiographic imaging findings with the ERCP results. Results: Of 21 patients with choledochoceles, nine (43%) were correctly dia gnosed on cholangiography. A radiolucent halo was present in six (28%) pati ents; four of these cases showed optimal duodenal filling, one showed faint duodenal filling, and one showed poor duodenal filling. The shapes of the distal CBD were bulbous, conelike, and blunt. Morphologic changes such as c ollapsing and bulging of the choledochocele could be seen in 12 (57%) patie nts on serial cholangiography. Waists were seen in 11 (52%), pseudowebs in four (19%), and wrinkling of the distal CBD in seven (33%). Conclusion: Cholangiography should be obtained with optimal timing and adeq uate conditions to diagnose choledochocele correctly.