eMedicine Specialties > Radiology > Gastrointestinal

Choledochal Cyst: Follow-up

Author: Michael AJ Sawyer, MD, Consulting Staff, Department of Surgery, Southwestern Medical Center; Consulting Staff, Department of Surgery, Comanche County Memorial Hospital; Consulting Staff, Great Plains Surgical Clinic, Inc
Coauthor(s): Manish K Varma, MD, Chief of Interventional Radiology, Department of Radiology, Tripler Army Medical Center; Thomas F Murphy, MD, Chief of Abdominal Imaging Section, Department of Radiology, Tripler Army Medical Center
Contributor Information and Disclosures

Updated: Jul 30, 2009

Intervention

The treatment for choledochal cysts is surgical. The treatment of choice for a type I choledochal cyst is complete excision of the cyst with construction of a Roux-en-Y biliary-enteric anastomosis to restore biliary continuity with the gastrointestinal tract.42

Surgical specimen.

Surgical specimen.

[ CLOSE WINDOW ]
Surgical specimen.

Surgical specimen.



Roux-en-Y hepaticojejunostomy to restore biliary-...

Roux-en-Y hepaticojejunostomy to restore biliary-enteric continuity following resection of choledochal cyst

[ CLOSE WINDOW ]
Roux-en-Y hepaticojejunostomy to restore biliary-...

Roux-en-Y hepaticojejunostomy to restore biliary-enteric continuity following resection of choledochal cyst


 
 

Type II choledochal cysts can usually be excised entirely, and the defect in the common bile duct can be closed primarily over a T-tube. This approach can be used because, typically, type II choledochal cysts are lateral diverticula of the bile duct.

Therapy for type III choledochal cysts, or choledochoceles, depends on the size of the lesion. Choledochoceles with a diameter of 3 cm or less may be approached endoscopically and effectively treated by means of sphincterotomy. Choledochoceles larger than 3 cm in diameter are often associated with some degree of duodenal obstruction. These cysts are excised surgically by using a transduodenal approach. If the pancreatic duct is found to be entering the choledochocele, it must be reimplanted into the duodenum after the cyst is excised.

For type IV choledochal cysts, the dilatated extrahepatic duct is completely excised, and a Roux-en-Y biliary-enteric anastomosis procedure is performed. No therapy is specifically directed at the intrahepatic ductal disease, except if intrahepatic ductal strictures, hepatolithiasis, or hepatic abscesses are present. In these patients, interventional radiologic techniques can be performed. If the disease is limited to specific hepatic segments or a lobe, these may be resected.

A type V choledochal cyst, or Caroli disease, is defined only by the dilatation of the intrahepatic ducts. If dilatation is limited to a single hepatic lobe, usually the left, the affected lobe is resected. Patients who have bilobar disease and signs of biliary cirrhosis, portal hypertension, or liver failure may be candidates for liver transplantation.

Recently, laparoscopic techniques have been successfully applied to the management of choledochal cysts. Good results have been achieved in both pediatric and adult populations and reported by several groups.43,44,45

A case report of embolization of a ruptured hepatic artery pseudoaneurysm was reported (see Angiography). Angiographic techniques with embolization of bleeding vessels seem feasible and can be used in these situations.

Gulati and colleagues described the use of US-guided percutaneous choledochal cystostomy in 2 infants.46 The children presented with severe hepatic function abnormalities, and 1 child had cholangitis. Choledochal cystostomy was successfully performed in each patient to decompress the biliary system until the infants were ready to undergo surgery.

For patients with choledochal cysts, bile duct stone formation or proteinaceous debris collection in the bile ducts is not uncommon because of poor bile flow. Kaneko and co-investigators described their results in connection with external biliary drainage in patients with choledochal cysts and protracted abdominal pain, jaundice, and vomiting.47 Simple external drainage effected resolution of symptoms in several patients. Filling defects were found in the distal bile duct in 22 patients. These resolved spontaneously or with irrigation in 19 patients (86%). In the remaining 3 patients, material in the bile duct was examined after surgery. It was composed mainly of proteinaceous debris (98%). The authors concluded that symptoms and biliary dysfunction are frequently caused by protein plugs or debris in patients with choledochal cysts. They proposed temporary external biliary drainage and bile duct irrigation as a therapeutic strategy to relieve the signs and symptoms.

Patients with choledochal cysts require lifelong follow-up monitoring. They remain at increased risk for development of cholangiocarcinoma, even after complete excision of the cyst.

Medicolegal Pitfalls

  • Misdiagnosis or the inability to make a diagnosis is associated with medical/legal pitfalls. The key to avoiding the pitfalls is not to place complete reliance on a single test or diagnostic modality.
  • Patients with choledochal cysts have a significant and potentially life-threatening anomaly of the biliary tract. With the possible exception of Caroli disease, surgery is always indicated and is the definitive therapy. Detailed information is required to plan the surgical approach.
  • Radiologists, gastroenterologists, and surgeons should work as a team in treating patients with choledochal cyst. The diagnostic workup should not cease until all are satisfied that enough information is available for operative planning. Such information usually includes data derived through a combination of US and CT scanning, MRI/MRCP, and ERCP.

Special Concerns

  • The first major special concern is the neonate presenting with prolonged jaundice. The workup should proceed expeditiously in these patients, especially to investigate the diagnosis of biliary atresia. Rapid identification of this anomaly and corrective surgical therapy are essential to providing an optimal outcome.
  • If a choledochal cyst is identified, definitive surgical therapy should be performed as soon as feasible. Progressive damage to the bile ducts and to the liver parenchyma is well described in association with these anomalies.
  • An association exists between APBJ and choledochal cysts, cholangiocarcinoma, and carcinoma of the gallbladder. The potential exists for imaging modalities to miss small cancers of the bile ducts and gallbladder; however, definitive surgery should be planned in all patients and should include resection of incidental lesions.
 


More on Choledochal Cyst

Overview: Choledochal Cyst
Imaging: Choledochal Cyst
Follow-up: Choledochal Cyst
Multimedia: Choledochal Cyst
References
Further Reading
[ CLOSE WINDOW ]

References

  1. Douglas AH. Case of dilatation of the common bile duct. Monthly J M Sci. 1852;14:97.

  2. Alonso-Lej F, Rever WB, Pessagno DJ. Congenital choledochal cyst, with a report of 2, and an analysis of 94, cases. Int Abstr Surg. Jan 1959;108(1):1-30. [Medline].

  3. Todani T, Watanabe Y, Narusue M, et al. Congenital bile duct cysts: classification, operative procedures, and review of thirty-seven cases including cancer arising from choledochal cyst. Am J Surg. Aug 1977;134(2):263-9. [Medline].

  4. Chokshi NK, Guner YS, Aranda A, Shin CE, Ford HR, Nguyen NX. Laparoscopic choledochal cyst excision: lessons learned in our experience. J Laparoendosc Adv Surg Tech A. Feb 2009;19(1):87-91. [Medline].

  5. Hua MC, Chao HC, Lien R, Lai JY, Lai MW, Kong MS. The different clinical and liver pathological characteristics between the newborns and infants with choledochal cysts. Chang Gung Med J. Mar-Apr 2009;32(2):198-203. [Medline].

  6. Kawarada Y, Das BC, Tabata M, Isaji S. Surgical treatment of type IV choledochal cysts. J Hepatobiliary Pancreat Surg. Apr 17 2009;[Medline].

  7. Miyano T, Yamataka A. Choledochal cysts. Curr Opin Pediatr. Jun 1997;9(3):283-8. [Medline].

  8. Muise AM, Turner D, Wine E, Kim P, Marcon M, Ling SC. Biliary atresia with choledochal cyst: implications for classification. Clin Gastroenterol Hepatol. Nov 2006;4(11):1411-4. [Medline].

  9. Lee HC, Yeung CY, Fang SB, Jiang CB, Sheu JC, Wang NL. Biliary cysts in children--long-term follow-up in Taiwan. J Formos Med Assoc. Feb 2006;105(2):118-24. [Medline].

  10. Lee HK, Park SJ, Yi BH, Lee AL, Moon JH, Chang YW. Imaging features of adult choledochal cysts: a pictorial review. Korean J Radiol. Jan-Feb 2009;10(1):71-80. [Medline].

  11. Lipsett PA, Pitt HA, Colombani PM, et al. Choledochal cyst disease. A changing pattern of presentation. Ann Surg. Nov 1994;220(5):644-52. [Medline]. [Full Text].

  12. Spinzi G, Martegani A, Belloni G, et al. Computed tomography-virtual cholangiography and choledochal cyst. Gastrointest Endosc. Dec 1999;50(6):857-9. [Medline].

  13. Lam WW, Lam TP, Saing H, et al. MR cholangiography and CT cholangiography of pediatric patients with choledochal cysts. AJR Am J Roentgenol. Aug 1999;173(2):401-5. [Medline].

  14. Kepczyk T, Angueira CE, Kadakia SC, et al. Choledochal cyst mimicking a pancreatic pseudocyst. J Clin Gastroenterol. Mar 1995;20(2):139-41. [Medline].

  15. Oto A, Ernst R, Ghulmiyyah L, Hughes D, Saade G, Chaljub G. The role of MR cholangiopancreatography in the evaluation of pregnant patients with acute pancreaticobiliary disease. Br J Radiol. Apr 2009;82(976):279-85. [Medline].

  16. Chavhan GB, Babyn PS, Manson D, Vidarsson L. Pediatric MR cholangiopancreatography: principles, technique, and clinical applications. Radiographics. Nov-Dec 2008;28(7):1951-62. [Medline].

  17. Weber C, Kuhlencordt R, Grotelueschen R, Wedegaertner U, Ang TL, Adam G, et al. Magnetic resonance cholangiopancreatography in the diagnosis of primary sclerosing cholangitis. Endoscopy. Sep 2008;40(9):739-45. [Medline].

  18. Sugiyama M, Baba M, Atomi Y, et al. Diagnosis of anomalous pancreaticobiliary junction: value of magnetic resonance cholangiopancreatography. Surgery. Apr 1998;123(4):391-7. [Medline].

  19. Yu ZL, Zhang LJ, Fu JZ, et al. Anomalous pancreaticobiliary junction: image analysis and treatment principles. Hepatobiliary Pancreat Dis Int. Feb 2004;3(1):136-9. [Medline].

  20. Irie H, Honda H, Jimi M, et al. Value of MR cholangiopancreatography in evaluating choledochal cysts. AJR Am J Roentgenol. Nov 1998;171(5):1381-5. [Medline].

  21. Matos C, Nicaise N, Devière J, et al. Choledochal cysts: comparison of findings at MR cholangiopancreatography and endoscopic retrograde cholangiopancreatography in eight patients. Radiology. Nov 1998;209(2):443-8. [Medline].

  22. Kim SH, Lim JH, Yoon HK, et al. Choledochal cyst: comparison of MR and conventional cholangiography. Clin Radiol. May 2000;55(5):378-83. [Medline].

  23. De Backer AI, Van den Abbeele K, De Schepper AM, et al. Choledochocele: diagnosis by magnetic resonance imaging. Abdom Imaging. Sep-Oct 2000;25(5):508-10. [Medline].

  24. Matsufuji H, Araki Y, Nakamura A, et al. Dynamic study of pancreaticobiliary reflux using secretin-stimulated magnetic resonance cholangiopancreatography in patients with choledochal cysts. J Pediatr Surg. Oct 2006;41(10):1652-6.

  25. Chijiiwa K, Koga A. Surgical management and long-term follow-up of patients with choledochal cysts. Am J Surg. Feb 1993;165(2):238-42. [Medline].

  26. Stringer MD, Dhawan A, Davenport M, et al. Choledochal cysts: lessons from a 20 year experience. Arch Dis Child. Dec 1995;73(6):528-31. [Medline].

  27. Rha SY, Stovroff MC, Glick PL, et al. Choledochal cysts: a ten year experience. Am Surg. Jan 1996;62(1):30-4. [Medline].

  28. Saing H, Han H, Chan KL, et al. Early and late results of excision of choledochal cysts. J Pediatr Surg. Nov 1997;32(11):1563-6. [Medline].

  29. Lee HC, Yeung CY, Chang PY, et al. Dilatation of the biliary tree in children: sonographic diagnosis and its clinical significance. J Ultrasound Med. Mar 2000;19(3):177-82; quiz 183-4. [Medline].

  30. Mackenzie TC, Howell LJ, Flake AW, et al. The management of prenatally diagnosed choledochal cysts. J Pediatr Surg. Aug 2001;36(8):1241-3. [Medline].

  31. Chen CP, Cheng SJ, Chang TY, et al. Prenatal diagnosis of choledochal cyst using ultrasound and magnetic resonance imaging. Ultrasound Obstet Gynecol. Jan 2004;23(1):93-4. [Medline].

  32. Benhidjeb T, Chaoui R, Kalache K, et al. Prenatal diagnosis of a choledochal cyst: a case report and review of the literature. Am J Perinatol. May 1996;13(4):207-10. [Medline].

  33. Sgro M, Rossetti S, Barozzino T, et al. Caroli's disease: prenatal diagnosis, postnatal outcome and genetic analysis. Ultrasound Obstet Gynecol. Jan 2004;23(1):73-6. [Medline].

  34. Sato M, Ishida H, Konno K, et al. Choledochal cyst due to anomalous pancreatobiliary junction in the adult: sonographic findings. Abdom Imaging. Jul-Aug 2001;26(4):395-400. [Medline].

  35. Kao PF, Huang MJ, Tzen KY, et al. The clinical significance of gall-bladder non-visualization in cholescintigraphy of patients with choledochal cysts. Eur J Nucl Med. Nov 1996;23(11):1468-72. [Medline].

  36. Aigner RM, Fueger GF, Schimpl G. Cholescintigraphy in the evaluation of bile flow after Roux-en-Y hepatico-jejunostomy and hepatico-antrostomy in infants with choledochal cysts. Pediatr Radiol. Nov 1997;27(11):850-4. [Medline].

  37. Lin WY, Lin CC, Changlai SP, et al. Comparison technetium of Tc-99m disofenin cholescintigraphy with ultrasonography in the differentiation of biliary atresia from other forms of neonatal jaundice. Pediatr Surg Int. 1997;12(1):30-3. [Medline].

  38. Johnson K, Alton HM, Chapman S. Evaluation of mebrofenin hepatoscintigraphy in neonatal-onset jaundice. Pediatr Radiol. Dec 1998;28(12):937-41. [Medline].

  39. Rajnish A, Gambhir S, Das BK, et al. Classifying choledochal cysts using hepatobiliary scintigraphy. Clin Nucl Med. Dec 2000;25(12):996-9. [Medline].

  40. Eliscu EH, Weiss GM. Hematobilia due to a pseudoaneurysm complicating a choledochal cyst. AJR Am J Roentgenol. Oct 1988;151(4):783-4. [Medline].

  41. Kirimlioglu V, Yilmaz S, Katz DA, et al. Choledochal cyst spontaneously rupturing the hepatic artery. Dig Dis Sci. Mar 2000;45(3):544-8. [Medline].

  42. Vegting IL, Tabbers MM, Taminiau JA, Aronson DC, Benninga MA, Rauws EA. Is endoscopic retrograde cholangiopancreatography valuable and safe in children of all ages?. J Pediatr Gastroenterol Nutr. Jan 2009;48(1):66-71. [Medline].

  43. Le DM, Woo RK, Sylvester K, et al. Laparoscopic resection of type 1 choledochal cysts in pediatric patients. Surg Endosc. Feb 2006;20(2):249-51.

  44. Jang JY, Kim SW, Han HS, et al. Totally laparoscopic management of choledochal cysts using a four-hole method. Surg Endosc. Nov 2006;20(11):1762-5.

  45. Srimurthy KR, Ramesh S. Laparoscopic management of pediatric choledochal cysts in developing countries: review of ten cases. Pediatr Surg Int. Feb 2006;22(2):144-9.

  46. Gulati MS, Srivastava DN, Paul SB, et al. Pre-operative management of congenital choledochal cyst with ultrasound-guided percutaneous choledochalcystostomy. Australas Radiol. Nov 1999;43(4):514-6. [Medline].

  47. Kaneko K, Ando H, Ito T, et al. Protein plugs cause symptoms in patients with choledochal cysts. Am J Gastroenterol. Jun 1997;92(6):1018-21. [Medline].

  48. Bratu I, Laberge JM, Khalifé S, et al. Regression of antenatally diagnosed localized Caroli's disease. J Pediatr Surg. Sep 2000;35(9):1390-3. [Medline].

  49. Brine DR, Soulen RL. Pancreaticobiliary carcinoma associated with a large choledochal cyst: role of MRI and MR cholangiopancreatography in diagnosis and preoperative assessment. Abdom Imaging. May-Jun 1999;24(3):292-4. [Medline].

  50. Carr-Locke DL, Conn MI, Faigel DO, et al. Technology status evaluation: magnetic resonance cholangiopancreatography: November 1998. From the ASGE. American Society for Gastrointestinal Endoscopy. Gastrointest Endosc. Jun 1999;49(6):858-61. [Medline].

  51. Chen CP. Ultrasound-guided needle aspiration of a fetal choledochal cyst. Ultrasound Obstet Gynecol. Feb 2001;17(2):175-6. [Medline].

  52. Custis K, Brown C, El Younis CM. Common biliary tract disorders. Clin Fam Pract. 2000;2:141-54.

  53. Dinsmore JE, Murphy JJ, Jamieson D. Pediatric surgical images: MRCP evaluation of choledochal cysts. J Pediatr Surg. May 2001;36(5):829-30. [Medline].

  54. Gallivan EK, Crombleholme TM, D'Alton ME. Early prenatal diagnosis of choledochal cyst. Prenat Diagn. Oct 1996;16(10):934-7. [Medline].

  55. Groebli Y, Meyer JL, Tschantz P. Choledochocele demonstrated by computed tomographic cholangiography: report of a case. Surg Today. 2000;30(3):272-6. [Medline].

  56. Hewitt PM, Krige JE, Bornman PC, et al. Choledochal cysts in adults. Br J Surg. Mar 1995;82(3):382-5. [Medline].

  57. Hussain SZ, Bloom DA, Tolia V. Caroli's disease diagnosed in a child by MRCP. Clin Imaging. Sep-Oct 2000;24(5):289-91. [Medline].

  58. Jan YY, Chen HM, Chen MF. Malignancy in choledochal cysts. Hepatogastroenterology. Mar-Apr 2000;47(32):337-40. [Medline].

  59. Jan YY, Chen HM, Chen MF. Malignancy in choledochal cysts. Hepatogastroenterology. Jan-Feb 2002;49(43):100-3. [Medline].

  60. Kabra V, Agarwal M, Adukai TK, et al. Choledochal cyst: a changing pattern of presentation. ANZ J Surg. Mar 2001;71(3):159-61. [Medline].

  61. Kim HJ, Kim MH, Lee SK, et al. Normal structure, variations, and anomalies of the pancreaticobiliary ducts of Koreans: a nationwide cooperative prospective study. Gastrointest Endosc. Jun 2002;55(7):889-96. [Medline].

  62. Kim JE, Lee JK, Lee KT, et al. The clinical significance of common bile-duct dilatation in patients without biliary symptoms or causative lesions on ultrasonography. Endoscopy. Jun 2001;33(6):495-500. [Medline].

  63. Kim MJ, Park YN, Han SJ, et al. Biliary atresia in neonates and infants: triangular area of high signal intensity in the porta hepatis at T2-weighted MR cholangiography with US and histopathologic correlation. Radiology. May 2000;215(2):395-401. [Medline]. [Full Text].

  64. Komuro H, Makino SI, Yasuda Y, et al. Pancreatic complications in choledochal cyst and their surgical outcomes. World J Surg. Dec 2001;25(12):1519-23. [Medline].

  65. Liu CL, Fan ST, Lo CM, et al. Choledochal cysts in adults. Arch Surg. Apr 2002;137(4):465-8. [Medline].

  66. Miller WJ, Sechtin AG, Campbell WL, et al. Imaging findings in Caroli's disease. AJR Am J Roentgenol. Aug 1995;165(2):333-7. [Medline].

  67. Nagi B, Kochhar R, Bhasin D, et al. Endoscopic retrograde cholangiopancreatography in the evaluation of anomalous junction of the pancreaticobiliary duct and related disorders. Abdom Imaging. Nov-Dec 2003;28(6):847-52. [Medline].

  68. Narasimhan KL, Chowdhary SK, Rao KL. Management of accessory hepatic ducts in choledochal cysts. J Pediatr Surg. Jul 2001;36(7):1092-3. [Medline].

  69. Ng WT. Bile duct carcinogenesis after excision of extrahepatic bile ducts in pancreaticobiliary maljunction. Surgery. Sep 2000;128(3):492-4. [Medline].

  70. Norton KI, Glass RB, Kogan D, et al. MR cholangiography in the evaluation of neonatal cholestasis: initial results. Radiology. Mar 2002;222(3):687-91. [Medline]. [Full Text].

  71. Okada A. Developments in the treatment of choledochal cysts. J Pediatr Surg. May 2001;36(5):834. [Medline].

  72. Park KB, Auh YH, Kim JH, et al. Diagnostic pitfalls in the cholangiographic diagnosis of choledochoceles: cholangiographic quality and its effect on visualization. Abdom Imaging. Jan-Feb 2001;26(1):48-54. [Medline].

  73. Peng HC, Chen HC, Chang WT, et al. Antenatal diagnosis and early surgery for choledochal cyst: a report of two cases. Chung Hua I Hsueh Tsa Chih (Taipei). Jan 1996;57(1):79-83. [Medline].

  74. Shi LB, Peng SY, Meng XK, et al. Diagnosis and treatment of congenital choledochal cyst: 20 years' experience in China. World J Gastroenterol. Oct 2001;7(5):732-4. [Medline].

  75. Shimizu T, Suzuki R, Yamashiro Y, et al. Magnetic resonance cholangiopancreatography in assessing the cause of acute pancreatitis in children. Pancreas. Mar 2001;22(2):196-9. [Medline].

  76. Spottswood SE, Jolles PR, Haynes JH, et al. Choledochal cyst with biliary atresia: scintigraphy and correlative imaging. Clin Nucl Med. Jun 2001;26(6):555-6. [Medline].

  77. Todani T, Urushihara N, Morotomi Y, et al. Characteristics of choledochal cysts in neonates and early infants. Eur J Pediatr Surg. Jun 1995;5(3):143-5. [Medline].

  78. Tsuchida Y, Takahashi A, Suzuki N, et al. Development of intrahepatic biliary stones after excision of choledochal cysts. J Pediatr Surg. Feb 2002;37(2):165-7. [Medline].

  79. Vingan HL. Magnetic resonance cholangiopancreatography versus ERCP: the "superbowl" of pancreaticobiliary imaging. Am J Gastroenterol. Aug 1997;92(8):1396-8. [Medline].

  80. Weyant MJ, Maluccio MA, Bertagnolli MM, et al. Choledochal cysts in adults: a report of two cases and review of the literature. Am J Gastroenterol. Dec 1998;93(12):2580-3. [Medline].

  81. Yamataka A, Kuwatsuru R, Shima H. Initial experience with non-breath-hold magnetic resonance cholangiopancreatography: a new noninvasive technique for the diagnosis of choledochal cyst in children. J Pediatr Surg. Nov 1997;32(11):1560-2. [Medline].

  82. Yamataka A, Ohshiro K, Okada Y, et al. Complications after cyst excision with hepaticoenterostomy for choledochal cysts and their surgical management in children versus adults. J Pediatr Surg. Jul 1997;32(7):1097-102. [Medline].

[ CLOSE WINDOW ]

Keywords

choledochal cyst, bile duct cysts, Caroli's disease, congenital anomalies of the bile ducts, cystic dilatation, extrahepatic biliary tree, intrahepatic biliary radicles, choledochocele, cystic dilation, cyst dilation, cyst dilatation

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Michael AJ Sawyer, MD, Consulting Staff, Department of Surgery, Southwestern Medical Center; Consulting Staff, Department of Surgery, Comanche County Memorial Hospital; Consulting Staff, Great Plains Surgical Clinic, Inc
Michael AJ Sawyer, MD is a member of the following medical societies: American College of Surgeons, Society for Surgery of the Alimentary Tract, Society of American Gastrointestinal and Endoscopic Surgeons, and Society of Laparoendoscopic Surgeons
Disclosure: Nothing to disclose.

Coauthor(s)

Manish K Varma, MD, Chief of Interventional Radiology, Department of Radiology, Tripler Army Medical Center
Manish K Varma, MD is a member of the following medical societies: American College of Radiology, American Roentgen Ray Society, and Radiological Society of North America
Disclosure: Nothing to disclose.

Thomas F Murphy, MD, Chief of Abdominal Imaging Section, Department of Radiology, Tripler Army Medical Center
Disclosure: Nothing to disclose.

Medical Editor

Neela Lamki, MD, Professor, Department of Radiology, Sultan Qaboos University, Oman; Adjunct Professor, Department of Radiology, Baylor College of Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

Managing Editor

Abraham H Dachman, MD, FACR, Professor, Department of Radiology, The University of Chicago School of Medicine; Director of CT, Department of Radiology, The University of Chicago Hospitals
Abraham H Dachman, MD, FACR is a member of the following medical societies: Radiological Society of North America
Disclosure: iCAD, Inc. Consulting fee Consulting; iCAD, Inc. Grant/research funds Other; GE Healtcare, Inc. Honoraria Speaking and teaching

CME Editor

Robert M Krasny, MD, Consulting Staff, Department of Radiology, The Angeles Clinic and Research Institute
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

John Karani, MBBS, FRCR, Clinical Director of Radiology and Consultant Radiologist, Department of Radiology, King's College Hospital, London
John Karani, MBBS, FRCR is a member of the following medical societies: British Institute of Radiology, British Society of Interventional Radiology, Cardiovascular and Interventional Radiological Society of Europe, European Society of Gastrointestinal and Abdominal Radiology, European Society of Radiology, Radiological Society of North America, and Royal College of Radiologists
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.