Percutaneous transhepatic cholangiogram (PTCA)

Definition
Percutaneous transhepatic cholangiogram (PTCA) is a type of X-ray examination of the bile ducts inside and outside the liver, performed after a contrast medium is injected directly into a liver bile duct.

How the test is performed

The test is performed in a radiology department by a radiologist. You will be asked to lie on your back on the X-ray table. The upper right side of the abdomen is cleansed and a local anesthetic is given. A long, thin, flexible needle is then inserted through the skin into the liver.

With guidance from the fluoroscope (an X-ray machine that projects images onto a TV screen), the bile duct is located and the contrast medium injected. The contrast medium then flows through the ducts and can be seen on the fluoroscopic monitor.

How to prepare for the test

Inform the health care provider if you are pregnant. You will be given a hospital gown to wear and will be asked to remove all jewelry.

Infants and children:
The physical and psychological preparation you can provide for this or any test or procedure depends on your child’s age, interests, previous experiences, and level of trust. For specific information regarding how you can prepare your child, see the following topics as they correspond to your child’s age:

How the test will feel
There will be a sting as the anesthetic is given and some discomfort as the needle is advanced into the liver. You may be given medication for sedation and/or pain control. Generally, an X-ray causes little or no discomfort.

Why the test is performed

Bile is a by-product of protein metabolism which is created in the liver and excreted into the intestines via the bile ducts. If bile cannot be removed from the body, it collects in the blood and is seen as a yellow discoloration of the skin and eyes (jaundice).

As well, the pancreas creates digestive fluids which drain via a common bile duct into the intestine, and thus obstruction can prevent the drainage of the fluids and may cause pancreatitis (inflammation of the pancreas).

PTCA may distinguish between obstructive and non-obstructive causes of jaundice and pancreatitis. If there is an obstruction, it can then be located and described.

Normal Values

The bile ducts are normal in size and appearance for the age of the patient.

What abnormal results mean


The results may show ducts that are dilated which may indicate there is an obstruction. The obstruction may be caused by infection, scarring, stones, or cancer in the bile ducts, liver, pancreas, or region of the gallbladder.

Additional conditions under which the test may be performed include the following:

What the risks are

There is a slight chance of an allergic reaction to the contrast medium (iodine).

There is a slight chance of excessive blood loss, blood poisoning (Sepsis), and inflammation of the bile ducts.

Special considerations

ERCP (endoscopic retrograde cholangiopancreatography) is an invasive procedure performed by gastroenterologists to visualize the bile ducts and to remove obstructing stones. If a diagnostic ERCP cannot be performed, or has failed in the past, PTCA may be performed. MRCP (magnetic resonance cholangiopancreatography) is a newer, noninvasive imaging method, based on MRI, which provides similar views of the biliary ducts in multiple planes.

Johns Hopkins patient information

Last revised: December 7, 2012
by Mamikon Bozoyan, M.D.

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