Total bile duct obstruction. Prompt diagnosis by hepatobiliary imaging.

The value of hepatobiliary imaging for the early diagnosis of total bile duct obstruction is not well known. Four hundred eighteen technetium Tc 99m iprofenin (Pipida) hepatobiliary scans were reviewed, and the anatomic diagnosis was established by postmortem examination, laparotomy, endoscopic retrograde cholangiopancreatography, transhepatic cholangiography, or ultrasound. Sixty cases demonstrated the technetium Tc 99m iprofenin pattern of total bile duct obstruction. Of these, 41 had total bile duct obstruction, 14 had advanced hepatocellular disease, four had massive liver metastasis, and one had portal vein thrombosis. The test was 100% sensitive for the detection of total bile duct obstruction. When the bilirubin level was less than 10 mg/dL, the predictive value was 100%. As the bilirubin level rose to 15 and 20 mg/dL, the predictive value fell to 92% and 88%, respectively. If performed early, hepatobiliary scanning is the preferred test for suspected total bile duct obstruction.