Radiologic approach to obstructive jaundice and pancreatic disease.

The diagnostic evaluation of the jaundiced patient occasionally can pose a formidable problem to the clinician. Evaluation of pancreatic disease without jaundice can be still more frustrating since even laparotomy may be inconclusive.21 Obstructive jaundice can usually be diagnosed accurately by clinical and laboratory tests. However, with long-standing disease, and intrinsic hepatic disease with biliary stasis, the laboratory data frequently are misleading. In these cases radiologic evaluation is invaluable. Since surgery may be deleterious in patients with hepatocellular disease, accurate diagnosis is imperative. This paper will review the radiologic procedures which may be employed to evaluate patients with jaundice and those suspected of having pancreatic disease. Space does not permit discussion of history, physical or laboratory findings. Each radiologic procedure will be discussed separately emphasizing its applicability and accuracy. Plain film findings, barium studies, cholecystography, cholangiography, endoscopic pancreatocholangiography, radioisotopic examinations, ultrasound, direct cholangiography (percutaneous and transvenous), angiography and operative cholangiography will be discussed in separate sections. Inevitably, there will be some overlapping with the radiologic approach for investigation of hepatomegaly. A disproportionate amount of space will be devoted to ultrasound since it is a relatively new noninvasive procedure which is becoming readily available and is proving to be valuable for abdominal masses and particularly pancreatic pseudocyst. Only one of the authors (A.K.F.) has extensive experience in the field. Finally an outline of our radiologic approach to jaundice and pancreatic disease will be discussed.