Percutaneous transhepatic cholangiogram: X-ray of the bile ducts

A percutaneous transhepatic cholangiogram (PTCA) is an x-ray of the bile ducts. These are the tubes that carry bile from the liver to the gallbladder and small intestine.

How is the test is performed ?
The test is performed in a radiology department by a radiologist.

You will be asked to lie on your back on the x-ray table. The health care provider will clean the upper right and middle area of your belly area and then apply a numbing medicine.

X-rays are used to help the health care provider locate your liver and bile ducts. A long, thin, flexible needle is then inserted through the skin into the liver. The health care provider injects dye, called contrast medium, into the bile ducts. Contrast helps highlight certain areas so they can be seen. More x-rays are taken as the dye flows through the bile ducts into the small intestine. This can be seen on a nearby video monitor.

You will be given medicine to calm you (sedation) for this procedure.

How to Prepare for the test
Inform the health care provider if you are pregnant. You will be given a hospital gown to wear and will be asked to remove all jewelry.

You will be asked not to eat or drink anything for 6 hours prior to the exam.

Tell your health care provider if you are taking any blood thinners.

How will the test feel?
There will be a sting as the anesthetic is given. You may have some discomfort as the needle is advanced into the liver.

Why is the test performed?
This test can help diagnose the cause of a bile duct blockage.

Bile is a liquid released by the liver. It contains cholesterol, bile salts, and waste products. Bile salts help your body break down (digest) fats. A blockage of the bile duct can lead to jaundice (yellow discoloration of the skin), itching of the skin or infection of the liver, gallbladder or pancreas.

When it is performed, PTCA is usually the first part of a two-step process to relieve or treat a blockage.

  • The PTCA makes a "roadmap" of the bile ducts which can be used to plan the treatment.
  • After the roadmap is done the blockage can be treated by either placing a stent or a thin tube called a drain.
  • The drain or stent will help the body get rid of the bile from the body. That process is called Percutaneous Biliary Drainage-PTBD.

Risks
There is a slight chance of an allergic reaction to the contrast medium (iodine).

There is also a small risk of:

  • Damage to nearby organs
  • Excessive blood loss
  • Blood poisoning (sepsis)
  • Inflammation of the bile ducts.

Considerations
Most of the time, this test is done after endoscopic retrograde cholangiopancreatography (ERCP) test has been tried first. The PTC may be done if an ERCP test cannot be performed or has failed to clear the blockage.

A magnetic resonance cholangiopancreatography (MRCP) is a noninvasive imaging method, based on MRI. It also provides views of the bile ducts, but is not always possible to do this exam. Also, MRCP cannot be used to treat the blockage.

Dr Wasey Jilani
Dr.Wasey Mahmud Jilani
MBBS, FCPS, FVIR,
Fellowship in Diagnostic Radiology,
College of Physicians & Surgeons Pakistan,
Fellowship in Vascular Interventional Radiology

Clinic:
Monday to Saturday

Timing:
10am to 5pm

Appointments:
Nasir / Salman
(+92)213 529 2707