Cholecystography

Abstract

CHOLECYSTOGRAPHY has achieved universal recognition as a reliable method in the diagnosis of gall-bladder disease. It has made possible the diagnosis of many obscure gall-bladder conditions which could not otherwise be recognized. The test furnishes not only a means of ascertaining the functional activity of the gall bladder, but presents a relatively accurate anatomical picture, which is essential in the diagnosis of disease of this organ. Attention should also be directed to the fact that it may even reveal a normally functioning gall bladder, provided the pathological process has been eradicated. This had occurred in several instances in our series: the gall bladder functioned and appeared normal several years following the removal of stones. However, the diagnosis of gall-bladder disease by this method is not infallible and should be considered together with the clinical data, in the same way as any other laboratory test. There are differences of opinion as to its reliability, but as Kirklin (1) well states: “The variances are due primarily to the lack of knowledge as to where the line should be drawn between the normal and abnormal gall bladder, both anatomically and functionally.” There are also differences of opinion as to the method of administration of the dye, some preferring the intravenous, while most roentgenologists advise the use of the oral method. Although recognizing that the intravenous method is slightly more accurate, its slight advantage in accuracy does not appear to compensate for its disadvantages. As a matter of fact, the results of cholecystography obtained by either the oral or intravenous method differ but to a slight degree. They depend as regards both methods in a large measure upon the roentgen technic and interpretation Graham and his co-workers (2), Case (3), and others recommend the intravenous method as being the most reliable, but on account of the ease with which the oral procedure is performed and owing to the lessened severity of the reactions produced by the dye, this latter method is preferable according to my experience. The reliability of cholecystography is now unquestioned, regardless of the method employed. In some instances the slight difference obtained by the two methods may be due to faulty roentgen technic and interpretation. On the other hand, it is quite possible to obtain abnormal results even though the gall bladder may be perfectly normal. Plummer (4) observed that a certain type of patient characterized by certain stigmata, that is, easy fatigability, achlorhydria, low basal metabolic rate, is likely to respond eccentrically to cholecystography, the shadow being often faint or absent in these cases. The results of cholecystography by the intravenous method have been reviewed by Graham (5), who compiled 561 cases, with operative findings. Of 446 cases, 97.8 per cent were proven correct; but in the entire group the total was reduced to 90 per cent.