PERCUTANEOUS TRANSHEPATIC CHOLANGIOGRAPHY (PTCA)

Percutaneous transhepatic cholangiography, or PTCA for short, is an x-ray that helps show whether there is a blockage in the liver or the bile ducts. The bile ducts are tubes that carry bile. This bile is a yellowish-green fluid that is made by the liver, stored in the gallbladder, and helps digest fats. In order to see blockages, a dye needs to be injected directly into the drainage system of the liver. The dye can be seen moving through the ducts by the fluoroscope. This is a special x-ray machine that projects images on a TV screen. If there is a blockage, the dye will stop spreading at the blockage. This may be caused by a gallstone, cancer, or other growth.

PTCA has been used for years, but there are newer tests that are similar. In Endoscopic Retrograde Cholangiopancreatography, or ERCP, the dye is injected through a tube which is inserted through the mouth to the intestines. Magnetic Resonance Cholangiopancreatography, or MRCP, is a new non-invasive imaging method. It uses an MRI machine, similar to an x-ray, to obtain images without the need to insert tubes or needles.

PTCA is used to:

find cause of pain after gall bladder removal
tell if jaundice is caused by an obstruction or some other liver disease, and
find the site of obstruction

Prior to the test be sure to let your healthcare provider know if you:

are allergic to anesthetics (like lidocaine, numbing agents used by your dentist, x-ray dyes, or shell fish)
are taking Glucophage, a diabetes medication (you may need to stop taking this for 48 hours before the test)
are a diabetic on insulin (you may need to change the dose on the morning of the test)
are on regular doses of aspirin, non-steroidal anti-inflammatory drugs (NSAIDS), or a blood thinner, like coumadin; these should be stopped for at least 3 days prior to the test
could be pregnant; x-ray tests are not recommended for pregnant women

Preparations for the test may vary but usually you need to stop eating and drinking from midnight of the day of the test, or at least 8 hours before the test. The stomach must be empty in order to get clear x-ray images.

The test is done as an outpatient. And takes about 30 minutes. At the time of the test, an IV will be started and a mild sedative may be given. You will be asked to lie on your back on an x-ray table that tilts. The upper right side of the abdomen will be cleansed and a local anesthetic given. A long, thin, flexible needle will be inserted through the skin into the liver. The examiner will watch the dye moving through bile ducts. Still x-rays will also be taken. Enlarged ducts may indicate a blockage. If ducts are normal size, further testing may be necessary.

After the test, bed rest is required for at least 6 hours. This is necessary to make sure there is no bleeding from the site of the injection. The procedure poses a slight risk of bleeding or infection. You may notice a soreness for 1 to 2 days at the site where the needle was inserted into the skin.

Possible side effects of the contrast dye include nausea, vomiting, flushing, itching, sweating, and salivating. On very rare occasions a person may have an extreme allergic reaction to the contrast dye.

Call your provider right away if you have any of the following after the test:

pain in your right abdomen or shoulder
fever
dizziness
bloody or black bowel movements or
a tightening of the throat with difficulty breathing (Call 911, this is an emergency.)

Disclaimer: This content is reviewed periodically and is subject to change as new health information becomes available. The information provided is intended to be informative and educational and is not a replacement for professional medical evaluation, advice, diagnosis or treatment by a healthcare professional.

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