title: Diagnostic pitfalls in the cholangiographic diagnosis of choledochoceles: cholangiographic quality and its effect on visualization.
abstract: BACKGROUND
  We wanted to establish reasonable cholangiographic diagnostic criteria by determining the sensitivity of cholangiography in detecting choledochoceles and those factors that could compromise visualization of choledochoceles.
  
  
  METHODS
  Over 4 years, 21 patients (seven male, 14 female; mean age = 67 years) were confirmed as having choledochoceles on endoscopic retrograde cholangiopancreatography (ERCP). Cholangiographic diagnosis was made by following three criteria: a radiolucent halo around the distal common bile duct (CBD), bulbous dilatation of the distal CBD, and the presence of sequential morphologic changes on serial cholangiography. Any two or more combinations of these three criteria were considered enough to diagnose a choledochocele on cholangiography. We compared cholangiographic imaging findings with the ERCP results.
  
  
  RESULTS
  Of 21 patients with choledochoceles, nine (43%) were correctly diagnosed on cholangiography. A radiolucent halo was present in six (28%) patients; four of these cases showed optimal duodenal filling, one showed faint duodenal filling, and one showed poor duodenal filling. The shapes of the distal CBD were bulbous, conelike, and blunt. Morphologic changes such as collapsing and bulging of the choledochocele could be seen in 12 (57%) patients on serial cholangiography. Waists were seen in 11 (52%), pseudowebs in four (19%), and wrinkling of the distal CBD in seven (33%).
  
  
  CONCLUSIONS
  Cholangiography should be obtained with optimal timing and adequate conditions to diagnose choledochocele correctly.
authors: Department of Diagnostic Radiology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea.
authors: K B
authors: KB
authors: Park
authors: Y H
authors: YH
authors: Auh
authors: J H
authors: JH
authors: Kim
authors: M G
authors: MG
authors: Lee
authors: H K
authors: HK
authors: Ha
authors: P N
authors: PN
authors: Kim
authors: Y M
authors: YM
authors: Shin
authors: M H
authors: MH
authors: Kim
authors: H J
authors: HJ
authors: Kim
authors: Y I
authors: YI
authors: Min
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002758:Cholangiography; D002760:Cholangiopancreatography, Endoscopic Retrograde; D015529:Choledochal Cyst / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity