Fluoroscopic and Angiographic Practice: Hepatobiliary Clinical Applications

Comprehensive practice flashcards covering hepatobiliary fluoroscopy applications including T-tube cholangiograms, PTBD, ERCP, Bronchoscopy, PEG, and Vertebroplasty.

Postoperative cholangiography

Also known as a T-tube cholangiogram, it is performed to exclude biliary tract calculi or assess biliary leaks following surgery.

T-tube Procedure Timing

Usually performed $7-10$ days after a biliary operation.

Bubble vs. Stone Differentiation

A technique using gravity (tilting the couch head or feet down); bubbles will flow up while stones will flow down.

T-tube Contrast Prep

Uses $20-30\,ml$ of HOCM/LOCM 300 in a $1:1$ dilution.

Percutaneous transhepatic cholangiogram (PTC)

Contrast medium injection into the biliary system through the skin followed by imaging.

Hydatid disease

A contraindication for PTBD involving tapeworm infection.

Chiba needle

A $22G$ fine needle used for inserting into the liver during PTC/PTBD.

Biliary tree verification

Differentiated from blood vessels during needle insertion by its slow centrifugal flow and persistent delineation of a short ductal section.

Subcapsular space collection

A persisting curvilinear collection of contrast medium indicating the needle is in the subcapsular space of the liver rather than the biliary tree.

Endoscopic retrograde cholangiopancreatography (ERCP)

A combined endoscopic and radiographic procedure that is a primary method of direct cholangiography.

Choledocholithiasis

The presence of stones in the common bile duct, for which ERCP is the preferred examination method.

Normal CBD diameter

Typically ranges between $3-6\,mm$.

Normal pancreatic duct diameter

The mean diameter is $4\,mm$ at the distal end, decreasing towards the tail (range $1-4\,mm$).

ERCP Patient Positioning

The prone position is standard as it offers the best access for anterior-posterior fluoroscopic imaging.

Bronchoalveolar lavage

A procedure where $50$ to $200\,mL$ of sterile saline is infused into the distal bronchoalveolar tree and suctioned out to retrieve cells and microorganisms.

Percutaneous Endoscopic Gastrostomy (PEG)

A feeding tube procedure required when nutritional assistance is needed for more than $30$ days.

Pneumoperitoneum

A possible complication of gastrostomy involving air in the peritoneal cavity.

Percutaneous Vertebroplasty

A minimally invasive outpatient procedure where bone cement is injected into a vertebral body to treat spinal compression fractures.

Polymethylmethacrylate

The liquid and powder substance mixed with $15\,g$ of barium sulfate to create bone cement for vertebroplasty.

Transpedicular route

The preferred access path for vertebroplasty in the lumbar spine segments.

11G bone biopsy needle

The specific needle size advanced through the pedicle during a vertebroplasty procedure.