RadteraT-Tube Cholangiogram (Postoperative Biliary)
Fluoro+ ContrastAbdomen & Pelvisverify
Indications
- Postoperative evaluation of biliary tree after CBD exploration / cholecystectomy
- Detection of retained or recurrent stones
- Assessment of biliary strictures, leaks, or anastomotic integrity
- Confirm free drainage to duodenum before T-tube removal
Patient prep
- Typically performed ~7-10 days postoperatively (or per surgeon)
- Sterile cleansing of T-tube and connection
- Aspirate bile and flush gently; warn patient of transient discomfort
- Antibiotic considerations if biliary obstruction present
Contrast
AgentNonionic water-soluble iodinated contrast, often diluted to avoid masking small stones
Routevia indwelling T-tube into the biliary system
Dose~20-30 mL injected slowly under fluoroscopy
TimingReal-time fluoroscopy during slow injection and drainage to duodenum
Technique
- Sterile connection to T-tube; aspirate to remove air and bile
- Inject diluted water-soluble contrast SLOWLY under fluoroscopy (avoid high pressure)
- Fill intra- and extrahepatic ducts; obtain AP and both oblique spot images
- Confirm free flow of contrast into the duodenum (patency)
- Avoid injecting air bubbles (mimic calculi)
Series / Sequences
| # | Series / Sequence | Plane | Notes |
|---|---|---|---|
| 1 | Scout | AP RUQ | T-tube position, residual contrast |
| 2 | Early fill | AP | Common duct, filling defects |
| 3 | Oblique views | RPO/LPO | Separate overlapping ducts, intrahepatic radicles |
| 4 | Duodenal drainage | AP | Confirms patency to bowel |
Key points
- Inject SLOWLY at low pressure — high pressure can cause cholangiovenous reflux and bacteremia/septicemia, especially with obstruction
- Avoid air bubbles which mimic stones; aspirate before injecting
- Use diluted contrast so small stones are not obscured
- If filling defect/retained stone found, the T-tube tract can be used later for percutaneous stone extraction
- Confirm duodenal drainage before clamping/removing tube
References
• UT Southwestern Radiology Protocol: T-Tube Cholangiogram
• Radiopaedia: Normal T-tube cholangiogram
• Diagnostic value of T-tube cholangiography — PMC11514883
• Radiopaedia: Normal T-tube cholangiogram
• Diagnostic value of T-tube cholangiography — PMC11514883
Source: Researched — verify against your institution
Reference template — verify and adapt to your scanner, vendor and institution before clinical use. Not a substitute for clinical judgment.