• Nuclear Medicine and Molecular Imaging
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• 제42권sup1호
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• pp.66-70
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• 2008

Reports about FDG PET in biliary tumor are limited and there are almost no reports regarding its efficacy. Biliary tumor is divided to intrahepatic and extrahepatic bile duct cancer, and intrahepatic bile duct cancer can be further divided to peripheral type which occurs at lobular duct and hilar type which occurs at hepatic hilum. Surgical resection is the only curative method for bile duct tumor, and accurate staging plays an important role in deciding treatment modality. Among intrahepatic bile duct tumors, peripheral type and hilar type have the same histological characteristics, but different clinical manifestations and tumor growth pattern. On PET image, FDG uptake is also different between peripheral type and hilar type. Most of the former shows high FDG uptake at primary and metastasis site so it is very useful for determining stage and changing treatment plans. However, the later is diversified among low uptake and very high uptake. The FDG uptake pattern of hilar type is similar to that of extrahepatic bile duct cancer, and mucinous component is an important factor, which affects FOG uptake. When tumor cells are scattered in desmoplatsic stroma, then FDG uptake is low as well. In contrast, when FDG uptake is high, it is likely to be tubular type which has high tumor density. Tumor growth pattern also affects FDG uptake. Nodular type mostly takes higher FDG compared to infiltrative type. There are many cases where benign inflammatory diseases take high FDG that PET alone can not distinguish malignant lesion from benign lesion. In conclusion, studies about PET using FDG are still limited. Thus, it is hard to make accurate conclusion about the roles of PET or PET/CT in biliary cancers, but peripheral type intrahepatic bile duct cancers and mass forming hilar and extrahepatic bile duct cancers appear to be good indications performing FDG PET or PET/CT.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제4권1호
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• pp.108-112
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• 2001

Nonsyndromic intrahepatic bile duct paucity is known to be associated with several kinds of etiology such as infection, chromosomal anomaly, metabolic disease and idiopathic. We report a rare case of intrahepatic bile duct paucity with congenital bilateral vocal cord paralysis and 13q deletion.

• Journal of Yeungnam Medical Science
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• 제39권2호
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• pp.161-167
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• 2022

Congenital web formations are extremely rare anomalies of the extrahepatic biliary tree. We herein report a case of common bile duct septum combined with multiple intrahepatic bile duct strictures in a 74-year-old female patient who was successfully treated with radiological intervention. The patient initially visited the hospital because of upper abdominal pain. Imaging studies revealed multifocal strictures with dilatation in both intra- and extrahepatic ducts; the final clinical diagnosis was congenital common bile duct web combined with multiple intrahepatic duct strictures. Surgical treatment was not indicated because multiple biliary strictures were untreatable, and the disease was clinically diagnosed as benign. The multiple strictures were extensively dilated twice through bilateral percutaneous transhepatic biliary drainage (PTBD) for 2 months. After 1 month of observation, PTBD catheters were successfully removed. The patient is doing well at 6 months after completion of the radiological intervention, with the maintenance of normal liver function. Congenital web of the bile duct is very rare, and its treatment may vary depending on the patterns of biliary stenosis. In cases where surgical intervention is not indicated for congenital web and its associated disease, radiological intervention with balloon dilatation can be a viable therapeutic option.

• Advances in pediatric surgery
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• 제15권1호
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• pp.11-17
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• 2009

Choledochal cyst is a congenital dilatation of the bile duct. Intrahepatic bile duct dilatation of type IVa by Todani's classification at the time of diagnosis resolved spontaneously after cyst excision and hepaticojejunostomy in many cases. It should be distinguished from the true cystic dilatation of the intrahepatic ducts, which tends to persist, albeit after some regression. We therefore studied postoperative intrahepatic duct dilatation changes in choledochal cyst. A total of seventy-six choledochal cysts were managed at the Division of Pediatric Surgery, Department of Surgery, Samsung Medical Center from May 1995 to December 2005. The ratio of males to females was 1:2.8. Preoperative radiologic diagnosis by Todani's classification was Type I (n=52, 68.4 %), II (n=1, 1.3 %), IVa (n=23, 30.3 %). Among fifty-five patients with intrahepatic bile duct dilatation we were able to follow up forty-eight by ultrasonography. Twenty-two patients were type IVa, and twenty-six patients were type I and showed intrahepatic duct dilatation. Mean follow-up duration was 35.3 months (9~105 months). Complete regression of dilated intrahepatic duct was observed in fifteen patients of type IVa and twenty-four patients of type I. Incomplete regression of dilated intrahepatic duct was observed in six patients in type IVa and two patients in type I. Only one patient in type IVa showed no change in ductal dilatation during a follow-up period of 15 months. We conclude that true type IVa is much less frequent than what was diagnosed preoperatively by imaging study. Therefore in type IVa patients who are diagnosed preoperatively the decision to perform liver resection should be carefully considered. Postoperative long term follow up of choledochal cyst with intrahepatic bile duct dilation is needed.

• 대한방사선기술학회지:방사선기술과학
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• 제20권1호
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• pp.43-49
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• 1997

Purpose of this paper is to extend help for clinical application in balloon cholangiography on patients who have undergone endoscopic sphincterotomy, impacted stones of intrahepatic duct, and missed bile duct because of other diseases in operating endoscopic retrograde cholangiopancreatography. This study was done for the patients who had clinical signs of biliary diseases from January to December In 1996. We studied 45 patients who had endoscopic sphincterotomy, re-examination after interventional treatment of the endoscopic retrograde cholangiopancreatography, and uncertain diagnosis due to common bile duct and intrahepatic duct those are not filled with contrast media. Balloon cholangiography was performed in case of uncertain diagnosis while operating endoscopic retrograde cholangiopancreatography. First of all, we insert balloon catheter Into the working channel of treatment jejunofiberscope and remove treatment Jejunofiberscope after ballooning, and lastly take biliary tract X-ray after Injection and changing position of patient. The results of this study were as follows. (1) In classification of diseases, stones of gall bladder, those of common bile duct, and those of intrahepatic duct were 30 cases, fistula was 1 case. (2) In total cases of 45, only diagnosis were 25 cases, interventional treatment were 20 cases. (3) In case of interventional treatment, endoscopic sphincterotomy and endoscopic nasobiliary drainage, and stone removal were about the same, 7, 7, 6 respectively. Balloon cholangiography will be useful to prevent patients from having repeated and unnecessary studies for the cases above explained. It is considered that this study will be useful for clinical application in terms of reducing medical expenses, pain while examination, and consultation hours.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제11권1호
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• pp.65-69
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• 2008

담도 폐쇄증은 수술적 치료가 필요하며 알라질 증후군은 대증적 치료가 가능하기 때문에 이를 감별하는 것이 중요하다. 저자들은 신생아기에 선천성 심장질환과 함께 담즙 정체 소견이 있는 환아에게서 원인 질환을 진단하는 과정에서 수술적 담관조영술 통해 제2형 담도 폐쇄증인 간관 폐쇄를 동반한 알라질 증후군 1예를 경험하였기에 보고하는 바이다.

• Journal of Trauma and Injury
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• 제27권3호
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• pp.89-93
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• 2014

Bile leaks are complications that are much more frequent after a high-grade liver injury than after a low-grade liver injury. In this report, we describe the management of bile leaks that were encountered after angiographic embolization in a 27-year-old man with a high-grade blunt liver injury. He had undergone an abdominal irrigation and drainage with a laparotomy on post-injury day (PID) 16 due to bile peritonitis and continuous bile leaks from percutaneous abdominal drainage. He required three percutaneous drainage procedures for a biloma and liver abscesses in hepatic segments 4, 5 and 8, as well as endoscopic retrograde cholangiopancreatography with biliary stent placement into the intrahepatic biloma via the common bile duct. We detected communication between the biloma and the bilateral intrahepatic duct by using a tubogram. Follow-up abdominal computed tomography on PID 47 showed partial thrombosis of the inferior vena cava at the suprahepatic level, and the patient received anticoagulation therapy with low molecular weight heparin and rivaroxaban. As symptomatic improvement was achieved by using conservative management, the percutaneous drains were removed and the patient was discharged on PID 82.

• 대한핵의학회지
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• 제32권2호
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• pp.161-167
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• 1998

목적: Tc-99m DISIDA 신티그라피에서 간 실질에 분절형으로 배설지연을 보이는 소견은 분절형 간내담관폐쇄의 소견으로 보고되고 있으나, 이러한 소견의 분절형 간내 담관폐쇄에서의 진단적 가치는 알려져 있지 않다. 본 연구에서는 간 실질 분절형 배설지연 소견의 분절형 간내 담관폐쇄 진단에서의 양성예측도와, 방사선학적 검사와 비교한 진단적 가치를 알고자하였다. 대상 및 방법: Tc-99m DISIDA 신티그라피에서 간 실질에 분절형 배설지연 소견을 보인 43명의 환자(48개 영상)를 대상으로하여 그 원인을 분석하고, 1개월 이내에 시행된 CT와 US와 비교하였다. 결과: 31예는 ERC나 PTC에 의해, 13예는 임상적 경과 관찰에 의해 분절형 담도 폐쇄가 확진되었고, 4예는 원인이 규명되지 않았다. 분절형 담관폐쇄에 대한 Tc-99m DISIDA 간담도 신티그라피의 양성예측도는 92% (44/48)이었다. US의 28%(5/ 18), CT의 13% (5/38)는 정상 소견이고, US의 17% (3/18), CT의 18% (7/38)에서는 담관 확장 소견만이 있었고, 원인이 되는 병변을 알 수 없었다. 결론: Tc-99m DISIDA 신티그라피에서 간 실질에 분절형 배설지연을 보이는 소견은 분절형 간내 담관폐쇄 진단에 높은 양성 예측도를 가진다. Tc-99m DISIDA 신티그라피는 특히 US나 CT가 정상인 경우에 분절형 담관폐쇄 진단에 선별검사로서 이용되어질 수 있을 것으로 생각된다. Tc-99m DISIDA 신티그라피의 분절형 담도관쇄 진단에서의 진단적 가치에 대한 전향적인 연구가 요구된다.

• 한국임상수의학회지
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• 제8권1호
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• pp.71-80
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• 1991

Clinical signs, serum chemical values and histological findings of hepatic tissue after partial and complete obstruction of common bile duct in Korean goats were investigated. Abnormal clinical signs were not observed in partial obstruction of common bile duct, but in complete obstruction clinical signs such as jaundice, urine color change, were observed. Serum total bilirubin, total cholesterol, aspartate aminotransferase, sorbitol dehydrogenase, gamma glutamyltranspeptidase, and total protein values increased on the 1-4th day and then gradually decreased to normal level in partial obstruction. However, they tend to increase persistently by the 24th day in complete obstruction of common bileduct. Histologic features of hepatic tissue in partial obstruction were not changed as compared with normal hepatic tissue. On the other hand, in complete obstruction of common bite duct there were moderate bile duct proliferation in a portal area, rupture of bile canaliculi, phagocytosis of bile pigment by Kupffer cells, periportal fibrosis, intrahepatic bile stasis and hepatic cell necrosis.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제17권2호
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• pp.121-124
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• 2014

Omega (${\omega}$)-3 polyunsaturated fatty acids appear to be effective in preventing and treating parenteral nutrition-associated liver disease, and several mechanisms were proposed for this observation. An 8-week-old male infant with cholestasis and acholic stool was diagnosed non-syndromic intrahepatic interlobular bile duct paucity by open-wedge liver biopsy. Initially he was treated with usual supportive medical therapy, including ursodeoxycholic acid. However, the clinical status and laboratory tests did not improve. Omega (${\omega}$)-3 polyunsaturated fatty acids (initially intravenous administration and oral administration later), were started and his liver function, including aminotransferase level and bilirubin levels normalized, and the ivory stool color turned green. We report the possible effectiveness of ${\omega}$-3 polyunsaturated fatty acids as a potent choleretic agent for non-syndromic intrahepatic interlobular bile duct paucity, a very rare structural pediatric hepatic disease.