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E1138. The Bile Ducts: Variations, Air Bubbles versus Stones, Benign and Malignant Diseases
Authors
  1. Shravan Sridhar Sridhar; University of New Mexico
  2. Nandan Keshav; University of New Mexico
  3. Masoud Shiehmorteza; University of New Mexico
  4. William Thompson; University of New Mexico
Background
Direct injection of water soluble contrast into the biliary system, Direct Cholangiography (DC), is being performed routinely by radiologists, surgeons and gastroenterologists. Knowledge of DC and their correct interpretation is important for patient care. Most radiology training programs have limited exposure to DC. Therefore, radiology residents have limited knowledge of the normal bile ducts, important anatomic variations and entities which can be diagnosed by DC. This is also true for many radiologists trained in the past 20-30 years as endoscopic retrograde cholangiopancreatography (ERCP) has decreased the number of DC performed and interpreted by radiologists. DC studies include ERCP, Intra-operative Cholangiography (IOC), Percutaneous Transhepatic Cholangiography (PTC) and T-tube cholangiography (TTC). Purpose: To illustrate the proper performance of DCs (ERCP, IOC, PTC and TTC and their correct interpretation.

Educational Goals / Teaching Points
To Illustrate: 1. Proper DC Techniques and their interpretation. 2. Normal bile duct anatomy 3. Important anatomic variations 4. Differentiation of air bubbles from bile duct stones 5. Differences and similarities between benign and malignant strictures 6. Detection of bile duct leaks

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
1. Proper performance of DC 2. Normal biliary anatomy compared to important anatomic variations. 3. Differentiation of air bubbles from bile duct stones 3. Benign strictures 4. Malignant strictures 5. Bile duct leaks after surgery and trauma

Conclusion
1. DC is being performed routinely by radiologists, surgeons and gastroenterologists. 2. Understanding how to correctly perform DC and their correct interpretation is important for patient care. 3. Since the introduction of ERCP, many radiology training programs have had limited exposure to DC which has limited exposure to these studies and reduced the knowledge of DCs for radiologists. 4. After reviewing this poster radiologists will have a better understanding of the performance of DC and their correct interpretation.