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Usefulness of a Percutaneous Transhepatic Coaxial Micropuncture Needle Technique in Patients with Nondilated Peripheral Intrahepatic Ducts

Constantin Cope1

1 Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104.



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  		Fig. 1. —Photograph shows 23-cm-long, 27-gauge (ga) micropuncture needle and 15-cm-long 22-gauge Chiba needle. Micropuncture needle fits through larger-gauge needle. Note bent tip of Chiba needle.

 


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  		Fig. 2. —64-year-old man with history of common bile duct calculi and nondilated ducts. Needle hepatogram shows injection through micropuncture needle that was advanced through Chiba needle, revealing opacification of lymphatics during initial needle pullback.

 


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  		Fig. 3A. —64-year-old man with suspected anastomotic duct stenosis after liver transplantation. Percutaneous transhepatic cholangiogram shows Chiba needle threaded over microneedle that has punctured tiny bile duct branch. Microneedle was subsequently removed to allow 0.018-inch guidewire to be advanced to bowel.

 


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  		Fig. 3B. —64-year-old man with suspected anastomotic duct stenosis after liver transplantation. Cholangiogram shows final insertion of 8.3-French biliary internal–external drain after transhepatic tract dilatation.

 


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  		Fig. 4. —Indirect percutaneous transhepatic cholangiogram in 47-year-old man with liver transplant malfunction. Duct opacification has occurred from parenchymal sinusoidal blush of contrast medium without overt coaxial microneedle puncture of duct. Second puncture was required to insert transhepatic drain catheter.

 

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