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Cholangioscopy Image Reference Guide





The intent of this reference guide is to help familiarize physicians with the appearance of biliary findings. Images of normal bile, cystic and hepatic ducts are presented to illustrate and familiarize the user with the appearance of a healthy, normal ducts and to contrast with the appearance of the biliary tree in a variety of pathologic states. Images featuring various types of benign and malignant conditions are represented in this guide, including strictures, villous lesions, stone disease, and more.


Image Reference Guide

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Normal Ducts

Throughout the biliary tree, the mucosa has a soft creamy pearly color. Mucosal depressions can be seen which become more apparent in the distal bile duct. They tend to disappear during luminal distention. The vascular pattern is well defined, the vessel contour is crisp and the vascular network is evident. Villous formation is also more noticeable in the distal bile duct. It tends to be uniform, avascular and of short stalk.
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Mucosal Depressions
Shallow Depressions
Normal Vascular Pattern
Normal Villous Pattern
Normal Common Bile Duct
Normal Cystic Duct / Common Bile Duct Junction
Normal Common Hepatic Duct
Normal Deep Left Hepatic Duct
Normal Deep Right Hepatic Duct
Normal Left Hepatic Duct Hilum
Normal Mucosa
Normal Papillary Area
Normal Right Hepatic Duct Hilum
Normal Right Hepatic Duct
Normal Suprapapillary
Normal Deep Left Hepatic Duct
Normal Intrahepatic Duct

Stone Diease (Benign)

The following images provide views of various types of stones and treatment via laser lithotripsy.
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Cystic Duct Stone
Intrahepatic Stone
Homium Laser Lithotripsy
Homium Laser Lithotripsy

Villous Lesions (Benign)

The following images depect various types of villous lesions.
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Villiform Formation
Villous Lesion

Benign Strictures

The following images demonstrate benign post-operative strictures treated with plastic stents. There are no vascular abnormalities, nodules or exophytic tissue.
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Benign Stricture
Benign Stricture Post-Liver Transplant
Common Bile Duct Stricture

Malignant Strictures

The following images depict various characteristics of malignant strictures.
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Characteristics of a Malignant Stricture
Cholangiocarcinoma Extension
Cholangiocarcinoma STX
Exophytic Vascular Tissue
Increased Vascularity
Tumor Vessel
Vascular Lakes

Filling Defects

Filling defects can be seen throughout the bile duct. They are usually not seen during cholangiography unless extensive (mucin).
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Filling Defects Showing Surgical Staples
Filling Defects Showing Surgical Staples
Desquamated Epithelium
Desquamated Epithelium
Stone Debris

Liver Transplant

The following images show both a donor and native cystic duct post-liver transplant.
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Biliary Anastamosis Four Years - Donor Duct
Biliary Anastamosis Six Months
Biliary Anastamosis 18 Months (Intrahepatic Stones)
Biliary Anastamosis Two Years
Native Cystic Duct; Biliary Anastamosis Four Years

Epithelial Bridge

The following images were taken during a procedure that was performed for biliary dilation of uncertain etiology. There was some resistance in advancing SDS around the hilum. An epithelial bridge was noted, which ruptured upon DSD advancement.
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Epithelial Bridge
Epithelial Bridge

Portal Vein Thrombosis & Cholangiopathy

The following images provide various views of portal vein thrombosis and portal cholangiopathy.
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Portal Vein Thrombosis & Portal Cholangiopathy
Portal Vein Thrombosis & Portal Cholangiopathy
Portal Vein Thrombosis & Portal Cholangiopathy
Portal Vein Thrombosis & Portal Cholangiopathy

Hemobilia

In this case, the patient had a bleeding site in the left hepatic duct (LHD), controlled with embolization. In the first branch of the LHD there is a tumor present with associated ulceration.
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Hemobilia