The intent of this reference guide is to help familiarize physicians with the appearance of biliary findings. Images of normal bile, cystic and hepatic ducts are presented to illustrate and familiarize the user with the appearance of a healthy, normal ducts and to contrast with the appearance of the biliary tree in a variety of pathologic states. Images featuring various types of benign and malignant conditions are represented in this guide, including strictures, villous lesions, stone disease, and more.
Throughout the biliary tree, the mucosa has a soft creamy pearly color. Mucosal depressions can be seen which become more apparent in the distal bile duct. They tend to disappear during luminal distention. The vascular pattern is well defined, the vessel contour is crisp and the vascular network is evident. Villous formation is also more noticeable in the distal bile duct. It tends to be uniform, avascular and of short stalk.
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The following images provide views of various types of stones and treatment via laser lithotripsy.
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The following images depect various types of villous lesions.
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The following images depict various characteristics of malignant strictures.
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Filling defects can be seen throughout the bile duct. They are usually not seen during cholangiography unless extensive (mucin).
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The following images show both a donor and native cystic duct post-liver transplant.
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The following images were taken during a procedure that was performed for biliary dilation of uncertain etiology. There was some resistance in advancing SDS around the hilum. An epithelial bridge was noted, which ruptured upon DSD advancement.
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The following images provide various views of portal vein thrombosis and portal cholangiopathy.
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In this case, the patient had a bleeding site in the left hepatic duct (LHD), controlled with embolization. In the first branch of the LHD there is a tumor present with associated ulceration.
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This collection of images were captured by Isaac Raijman, M.D., Houston, Texas
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