Percutaneous transhepatic cholangiogram
Definition
A percutaneous transhepatic cholangiogram (PTCA) is an x-ray of the bile ducts inside and outside the liver. The x-ray is taken after contrast medium (dye) is injected directly into the area being studied.
Alternative Names
PTCA; Cholangiogram - PTCAWhy the Test is Performed
Bile is a by-product of protein metabolism. It is created in the liver and excreted into the intestines via the bile ducts. If bile cannot be removed from the body, it collects in the blood and is seen as a yellow discoloration of the skin and eyes (jaundice).
Also, the pancreas creates digestive fluids which drain via a common bile duct into the intestine, and thus obstruction can prevent the drainage of the fluids and may cause pancreatitis (inflammation of the pancreas).
A PTCA test can help identify whether a blockage is causing the jaundice and pancreatitis.
How 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 upper right side of your abdomen will be cleansed and you will be given a local anesthetic. A long, thin, flexible needle is then inserted through the skin into the liver.
With guidance from the fluoroscope (an x-ray machine that projects images onto a TV screen), the bile duct is located and the contrast medium injected. The contrast medium then flows through the ducts and can be seen on the fluoroscopic monitor.
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.
How the Test Will Feel
There will be a sting as the anesthetic is given and some discomfort as the needle is advanced into the liver. You may be given medication for sedation and/or pain control. Generally, the x-ray itself causes little or no discomfort.
Risks
There is a slight chance of an allergic reaction to the contrast medium (iodine).
There is a slight chance of excessive blood loss, blood poisoning (sepsis), and inflammation of the bile ducts.
Considerations
A PTCA may be done if an endoscopic retrograde cholangiopancreatography ( ERCP) cannot be performed or has failed in the past.
An MRCP (magnetic resonance cholangiopancreatography) is a newer, non-invasive imaging method, based on MRI, which provides similar views of the bile ducts.
Normal Results
The bile ducts are normal in size and appearance for the age of the patient.
What Abnormal Results Mean
The results may show that the ducts are enlarged, which may indicate the ducts are blocked. The blockage may be caused by infection, scarring, or stones. It may also indicate cancer in the bile ducts, liver, pancreas, or region of the gallbladder.
See also:
- Blocked bile ducts
- Cholangitis (infection in common bile duct)
Reviewed By: Stuart Bentley-Hibbert, M.D., Ph.D., Department of Radiology, Weill Cornell Medical Center, New York, NY. Review provided by VeriMed Healthcare Network.
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