From: JAR Smith

What is this investigation?
Of what did the patient complain?
What other investigations are indicated?

This trans-hepatic percutaneous cholangiogram shows a dilated CBD in a patient with obstructive jaundice. This investigation is performed less often than in the past. The patient had symptoms of obstructive jaundice with pruritus and associated weight loss. Other investigations should include an ultrasound scan to detect the presence of gallstones, possibly an MRCP to obtain more information about the biliary tree and a CT scan to look for a pancreatic or ampullary malignancy. An ERCP would allow further imaging, cytology and biopsy and possible stenting. Endoscopic ultrasound is also increasingly used to aid diagnosis.