Intravenous Cholangiography

Friday, May 29, 2015

Intravenous Cholangiogram Procedure

Tomogram at 11 cm level, showing ducts (dots)
Intravenous Cholangiography (IVC) is rarely performed since, the relatively higher occurrence of reactions to the contrast medium and the availability of other diagnostic imaging procedures. When Intravenous Cholangiography (IVC) is done to study the biliary ducts of cholecystectomized patients. It is also used to study the biliary ducts and gallbladder of noncholecystectomized patients when these structures are not seen by OCG and when, because a patients has a symptoms of vomiting or diarrhea, a patient cannot retain the orally administered medium long enough for its absoption. In

cases of nonvisualization, immediately instituting the intravenous procedure may save time for the radiology department and the patient as well as spare the patient the rigors of having the intestinal tract prepared again.

Position of Patient:

Place the patient in the supine position for a preliminary or scout radiograph of the abdomen.
Place the patient in the RPO position 15° to 40° for an AP oblique projection of the biliary ducts.
Obtain a scout or localization radiograph and / or tomogram to check for centering and exposure factors.
Advice the patient that a hot flush may occur when the contrast medium is injected.
Timed from the completion of the injection, duct studies are ordinarily obtained at 10 minutes intervals until satisfactory visualization is obtained. Maximum opacification usually requires 30 to 40 minutes.

AP Oblique, RPO position showing ducts (dots)

Intravenous cholangiography is not generally indicated for patients who have liver disease or for those whose biliary ducts are not intact. The probability of obtaining radiographs of diagnostic value greatly decreases when the patient’s bilirubin is increasing or when it exceeds 2mg /dl. In cases of obstructive jaundice and postcholecystectomy, ultrasound has become the preffered technique for demonstrating the biliary system.

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