Abstract
BackgroundChallenges in the diagnosis of obstructive jaundice include locating the level of obstruction, knowing the cause of obstruction, and differentiating between benign and malignant causes. Imaging plays a significant role in detecting the causes of obstruction. Radiologists aim to diagnose biliary obstruction, its level, extent, and probable causes to determine the appropriate treatment for each case. MethodsOur study is a retrospective medical record review study. It included 150 patients who had ultrasound (US) diagnosis of biliary obstruction and underwent magnetic resonance cholangiopancreatography (MRCP) or endoscopic retrograde cholangiopancreatography (ERCP) in King Fahad Specialist Hospital, Buraidah. The patients’ medical records have been reviewed to measure the sensitivity and specificity of US, MRCP, and ERCP. ResultsStatistical analysis of the data showed that the sensitivity of US in detecting the most common cause of biliary obstruction, common bile duct (CBD) stone, was 26.6%, while the specificity was 100%. Comparing this sensitivity of US in detecting CBD stones to that of MRCP and ERCP, we obtained the following: US, 26.6%; MRCP, 62.9%; and ERCP, 62.4%. Although US was the least sensitive for detecting CBD stones, its specificity in this detection was 100%, while MRCP was 63.6%, and ERCP was 55.2%.Conclusion US is the best initial step for the diagnosis of biliary obstruction. However, MRCP and ERCP are more sensitive in detecting CBD stones compared to US. Also, compared to US, they have shown higher percentages in all aspects of detection: level, cause, and extent of biliary obstruction.
Highlights
Obstructive jaundice is a common problem, the diagnosis of biliary obstruction remains a challenge
Statistical analysis of the data showed that the sensitivity of US in detecting the most common cause of biliary obstruction, common bile duct (CBD) stone, was 26.6%, while the specificity was 100%
All medical records of patients who had been diagnosed with obstructive jaundice on US from January 1, 2016, to March 31, 2019, in King Fahad Specialist Hospital (KFSH), Buraidah, which is the largest hospital in this area, were reviewed
Summary
Obstructive jaundice is a common problem, the diagnosis of biliary obstruction remains a challenge. The biggest challenges are locating the level of obstruction, knowing the cause of obstruction, and differentiating between benign and malignant causes. The causes of biliary obstruction can be classified into benign and malignant. Benign biliary obstructions may include complicated choledochal cyst and Mirizzi syndrome. Malignant biliary obstructions are most caused by cholangiocarcinoma, pancreatic head cancer, gallbladder carcinoma, intrahepatic metastases, lymphoma, and metastatic lymphadenopathy [1]. Challenges in the diagnosis of obstructive jaundice include locating the level of obstruction, knowing the cause of obstruction, and differentiating between benign and malignant causes. Radiologists aim to diagnose biliary obstruction, its level, extent, and probable causes to determine the appropriate treatment for each case
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