Self assessment questions
| Answers on p 795. |
Breathlessness after percutaneous biliary drainage
H Patela, K S Hindleb, G Tsavellasa, A Huangaa Department
of Academic Surgery, Chelsea and Westminster Hospital, London SW10
9NH, UK, b Wycombe Hospital, High Wycombe, Buckinghamshire
Correspondence to: Mr Huang a.huang@ic.ac.uk
Submitted 14 August 2000;
Accepted 17 October 2000
| The first 150 words of the full text of this article appear below. |
A 77 year old woman presented with painless progressive jaundice and weight loss. She also had generalised pruritus and was passing dark urine and pale stools. On examination there was a palpable right upper quadrant abdominal mass. Plasma bilirubin level was 56 µmol/l and alkaline phosphatase was 350 U/l. Serum amylase was within normal limits. Abdominal ultrasound scan showed a dilated biliary tree and a distended gallbladder but there was no evidence of gallstones. Abdominal computed tomography was performed (fig 1). The patient underwent an endoscopic retrograde cholangiopancreaticogram (ERCP) and insertion of a biliary stent, with resolution of the jaundice.
| Figure Removed (Available Only in the Full Text) |
Ten days later the patient became jaundiced again and an abdominal
ultrasound suggested stent occlusion with recurrent biliary tree
dilatation. Percutaneous transhepatic cholangiography (PTC) with
external biliary drainage was performed. The patient gradually became
short of breath with right sided pleuritic pain and a thoracic radiograph was obtained (fig 2). Thoracocentesis
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