• Parasites, Hosts and Diseases
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• 제45권2호
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• pp.77-85
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• 2007

Among several diagnostic tools for clonorchiasis (Clonorchis sinensis infection), radiologic examinations are commonly used in clinical practices. During the 2 past decades, many reports regarding imaging findings of clonorchiasis were introduced. The basic imaging finding of clonorchiasis is diffuse dilatation of the peripheral intra-hepatic bile ducts, without dilation of the large intrahepatic or extrahepatic bile ducts. By this finding, however, active clonorchiasis cannot be differentiated from cured infection. Some recent radiologic studies suggested specific findings of active clonorchiasis. Besides direct demonstration of worms, increased periductal echogenicity on sonography and periductal enhancement on dynamic contrast-enhanced CT or MR imaging possibly represent active clonorchiasis. Those images of the liver clonorchiasis are known to be correlated with worm burdens (EPG counts) in their frequency and also severity. The images of cholangiocarcinoma associated with clonorchiasis show both the tumor with obstruction images and diffuse dilatation of the peripheral intrahepatic bile ducts. Radiological images can be a good practical alternative diagnostic method of clonorchiasis.

• 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.

• Parasites, Hosts and Diseases
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• 제37권2호
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• pp.77-83
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• 1999

To ascertain residual sonographic and histopathological findings of clonorchiasis after treatment, the present study evaluated sonographic findings in rabbits which were infected with 500 metacercariae of C.sinensis every 6 months for 18 months after treatment with praziquantel. The sonographic findings were analyzed in terms of intrahepatic bile duct dilatation and periductal echogenicity, and histopathological findings were observed after the last sonographic examination. Compared with the sonographic findings before treatment, dilatation of the intrahepatic bile ducts became mild to some degree in four of the seven cases and increased periductal echogenicity resolved in four of them. The histopathological specimens after 18 months showed that periductal inflammation has almost resolved but moderate dilatation of the intrahepatic ducts and mucosal hyperplasia persisted. The periductal fibrosis minimally resolved. The log-lasting sonographic findings in cured clonorchiasis make sonography less specific.

• 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.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제21권3호
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• pp.203-208
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• 2018

Purpose: The aim of this study was to describe our treatment experiences with patients who had acute abdomen (AA) with common bile duct (CBD) dilatation. Methods: The treatment outcomes in children with AA and CBD dilatation were retrospectively reviewed. According to the shape of the intrahepatic bile ducts on ultrasonography (US), the origin of the pain was estimated as choledochal cyst (CC) complication or choledocholithiasis in normal CBD. Patients with complicated CC underwent surgery, and patients with choledocholithiasis in a normal appearing CBD underwent symptomatic treatment initially. Results: Of the 34 patients, 30 (88.2%) were female. The mean age of the patients was $6.4{\pm}4.9$ (range, 0.8-17) years. Seventeen (50.0%) patients had CBD stones and 17 (50.0%) did not. Surgical treatment was performed in 20 (58.8%) patients, 2 of whom underwent preoperative stone removal with endoscopic retrograde cholangiopancreatography and an operation. Conservative treatment was applied in 12 (35.3%) patients (8 with and 4 without stones), 1 of whom developed symptom relapse and underwent an operation. Among the 8 patients with CBD stones, 4 (4/17, 23.5%) had complete resolution of the stones and recovery of the CBD diameter after conservative treatment. US findings of patients with stone showed a fusiform or cylindrical shape of the CBD in 14 (82.4%) patients. Conclusion: The presence of stones in the distal CBD and the US features of CBD dilatation may be helpful to diagnose and treat the causes of biliary dilatation. Conservative treatment can be considered as initial therapy in patients with uncomplicated CBD dilatation with stone.

• Parasites, Hosts and Diseases
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• 제47권1호
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• pp.19-23
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• 2009

We measured changes in sonographic findings of patients with clonorchiasis after a treatment in a highly endemic area. A total of 347 residents showed positive stool results for Clonorchis sinensis eggs in a village in northeastern China, and were treated with praziquantel. Of them, 132 patients underwent abdominal sonography both before and 1 year after treatment, and the changes in sonographic findings of 83 cured subjects were compared. Diffuse dilatation of intrahepatic bile ducts (DDIHD) was found in 82 patients (98.2%) before and 80 (96.4%) after treatment, which was improved in 3, aggravated in 1, and unchanged in 79 patients. Increased periductal echogenicity (IPDE) as observed in 42 patients (50.6%) before and 45 (54.2%) after treatment, which was improved in 5, aggravated in 8, and unchanged in 70 patients. Floating echogenic foci in the gallbladder (FEFGB) was detected in 32 patients (38.6%) before and 17 (20.5%) after treatment, which was improved in 20, aggravated in 5, and unchanged in 58 patients. Improvement of FEFGB only was statistically significantly (P = 0.004). The present results confirm that DDIHD and IPDE persist but FEFGB decreases significantly at 1 year after treatment. In a heavy endemic area, the sonographic finding of FEFGB may suggest active clonorchiasis 1 year after treatment.

• Parasites, Hosts and Diseases
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• 제42권1호
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• pp.7-17
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• 2004

This study describes an evaluation of the sonographic, cholangiographic, pathological, and immunological findings, and the protective effect shown by rats reinfected with Clonorchis sinensis. Eight experimental rat groups were, namely, a normal control, a primary infection control, a reinfection I (reinfection 7 week after treatment following 3-week infection), a reinfection II (reinfection 2 week after treatment following 8-week infection), a reinfection III (exploration of the intrahepatic bile ducts 1 week after reinfection 4 week after treatment following 4-week infection), a superinfection, a secondary infection control, and an infection following immunization group. Sonographic and cholangiographic findings showed moderate or marked dilatation of the bile duct confluence in the primary infection control, reinfection II, and secondary infection control groups. Juvenile worms survived in the intrahepatic bile ducts 1 week after reinfection following treatment in the reinfection III group. It was concluded that reinfecting juvenile worms found during the first week following reinfection failed to survive or grow further. Anatomical, pathophysiological, or immunological changes may induce protection from reinfection in rats.

• 대한방사선기술학회지:방사선기술과학
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• 제31권2호
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• pp.149-159
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• 2008

목 적: 지금까지의 경복부 초음파를 이용한 간외담관에 대한 검사는 주로 담낭과 간외 담도, 즉 총수담관(CBD)만을 확인하는 수준의 검사가 전부인 것처럼 여겨져 왔다. 그러나 저자들은 임상에서의 다양한 경험을 바탕으로 간외담도의 비정상 확장에 대해 분석할 수 있고, 담도질환 유무 및 관련성을 평가하는데 필요한 기술적 접근 방법에 대한 새로운 이론적 토대를 마련하였다. 이 새로운 이론을 기본으로 신뢰성 있는 검사 성적을 얻기 위하여 일정기간 교육 후 scanning 훈련을 시켜 그 효과를 평가함으로서 담관질환 검사의 새로운 기준을 정립코자 한다. 대상 및 방법: 초음파 교육생 30명을 대상으로 간외담관에 대한 새로운 이론에 근거하여 기술적 접근 방법에 대한 교육을 전수한 후 학생 1인당 3시간(30분${\times}$6회)을 배당하여 scanning 훈련을 집중였다. 교육 방법은 강사와 학생 1:1 방식으로 하였다. Scanning 훈련 후 평가 기준으로 모든 학생에게 5분 내에 간외담관 중에서 좌우 담관으로부터 (1) 담낭관 합류부(간외담관 및 담낭관), (2) 췌장 상부담관, (3) 췌두부내 담관, (4) 유두부내 공통관 등 네 분절을 명확하게 구분된 개념으로 scan하게 한 후 정확도를 평가하였다. 결 과: 기존의 교육과 훈련 방식은 간외담관에 대한 경복부 초음파검사의 신뢰도가 매우 낮고, 췌장 상부 담관에만 국한적으로 영상화할 수 있었다. 그러나 새로운 이론에 근거한 교육과 훈련을 마친 후 성적의 평가는 모든 학생(30명)이 (1) 담낭관 합류부(간외담관 및 담낭관), (2) 췌장 상부담관까지 객관성 있게 접근하였다. 24명의 학생이 (3) 췌두부내 담관 말단까지 접근하였으며, 1명의 학생만이 (4) 유두부내 공통관까지 영상화할 수 있었다. 결 론: 간내외 담관의 평가는 간내인성, 담관성 그리고 병태생리학적 다면 평가가 이뤄져야 하지만, 경복부초음파검사에 의해 간외담관을 유두부내 공통관까지 객관적이고 신뢰성 있게 영상화시킬 수 있다면 단순 감별진단 목적으로 시행하는 ERCP같은 환자에게 고통이 수반된 침습적인 검사를 대폭 줄일 수 있을 것이다. 따라서 저자들이 제시한 새로운 검사방법으로 간외 담관에 대한 기술적 접근 방법을 scanning 훈련하여 임상에 적용하게 된다면 초음파의 객관적인 신뢰도를 높일 수 있을 것으로 생각된다.

• Clinical and Experimental Pediatrics
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• 제59권5호
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• pp.239-241
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• 2016

Choledochal cyst is a dilation that encloses the intrahepatic or both extra- and intrahepatic portions of the biliary ducts. Postnatally, ultrasonography is the initial diagnostic modality of choice, allowing for precise measurements of intra- or extrahepatic duct dilatation and identification of stones and sludge. Symptoms depend on the age at presentation. Common bile duct malformations should be considered as a differential diagnosis of a cystic mass regardless of the cyst's size or patient's age, especially in children presenting with abdominal pain, jaundice, and palpable mass. To the best of our knowledge, we report the largest choledochal cyst in infancy.

• Investigative Magnetic Resonance Imaging
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• 제6권2호
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• pp.129-136
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• 2002

목적 : 총담관 확장을 유발하는 원인 중 결석과 종양을 제외한 여러 원인을 평가하는데 있어서 MRCP의 진단적 유용성을 알아보고자 하였다. 대상 및 방법 : ERCP와 MRCP를 모두 시행받은 환자 26명 (남:여=15:11, 평균연령 62세)을 대상으로 하였으며, 이들 중 12명은 역동적 MRCP를, 10명은 조영증강 MRI를 추가로 시행하였다. 총담관, 간내 담도, 췌관 등의 확장 정도, 간내 담도 결석, 췌장 가성낭종, 유두부의 부종이나 결절성 종대 등을 관찰하였다. 총담관은 T2-강조 관상영상에서 담낭절제술을 받지 않은 경우 7 mm 이상, 절제술을 받은 경우 10 mm 이상을 비정상적인 확장으로 판정하였다. 결과 : 담낭절제술을 받지 않은 환자의 총담관 평균 직경은 12.7mm(n=21, 9-19 mm)였고, 절제술을 받은 환자의 평균 직경은 13.0 mm(n=5, 10-15mm)였다(p〉0.05). MRCP에서 담관염 11명(42.3%), 만성 췌장염 8명(30.8%), 원위부 총담관 협착 6명(23.1%), 팽대부 주위 게실 3명(11.5%), Vater 팽대부 협착, 오디 괄약근 기능장애, 췌장 두부의 국소적 췌장염이 각각 2명 (7.7%), 유두염, 췌장 두부 가성낭종에 의한 총담관 확장, 총담관 내 회충이 각각 1명(3.8%) 있었다. 췌관의 확장은 10명(38.5%)에서 보였고, 십이지장 게실은 3명(11.5%)에서 관찰되었다. 역동적 MRCP(n=12)에서 2명(16.7%)은 일반 MRCP에서 보이지 않던 원위부 총담관이 관찰되었고, 조영증강 MRI를 시행한 10명 중 1명 (10.0%)만이 유두염의 소견을 보였다. 결론 : 비결석, 비종양성 총담관 확장의 원인을 찾는데 있어서 MRCP는 총담관 원위부 협착 및 만성 췌장염, 역동적 MRCP를 이용한 생리적 총담관의 확장, 조영증강 MRI 를 통한 담관염 및 담관 외 병소의 발견 등에 있어서 도움이 되는 것으로 생각된다.