A T-tube cholangiogram is an x-ray of the biliary duct system used to detect blockages. Contrast material is injected through a T-tube, which is sometimes placed during liver or gallbladder surgery, allowing visualization of the ducts. It can show remaining gallstones or fragments after surgery and help doctors determine when to remove the T-tube. There are other cholangiogram methods like MRCP that do not require contrast injection.

1. T-tube Cholangiogram

2. What is a T-tube Cholangiogram?
• A T-tube cholangiogram is an x-ray of the biliary
duct system.
• These ducts transport bile between your liver,
gallbladder, and small intestine are not seen on
radiographs without the use of contrast
materials.
• This contrast is injected via a T-tube, which is
normally put in place during surgical procedures
ranging from liver transplantation to
cholcystectomy.

3. Biliary duct system

4. What can a T-tube Cholangiogram
show?
• This exam can show blockages within your
common bile duct or hepatic ducts.
• The most common reason for this exam is to look
for remaining stones or stone fragments in the
ducts after surgery.
• This gives your doctor important information that
may help in your diagnosis and treatment.
• It can help your doctor decide when to remove
your T-tube.

5. What does a T-tube Cholangiogram look like?
This is the initial image demonstrating contrast in the T-tube as well as in
portions of the common bile duct and the pancreatic duct.

6. What does a T-tube Cholangiogram look like?
In this second image of the series, we see that the contrast has spread throughout the
right and left hepatic ducts superiorly. We can see the cystic stump clearly with no
evidence of leakage. Inferiorly, we can see the common bile duct as it enters the
duodenum.

7. What does a T-tube Cholangiogram look like?

8. What does a T-tube Cholangiogram look like?

9. What does a T-tube Cholangiogram look like?

10. What does a T-tube Cholangiogram look like?

11. Are there other methods for obtaining
a Cholangiogram?
• There are various techniques used to
introduce radiographic contrast into the body,
including:
– Percutaneous transhepatic cholangiography (PTC).
– Intraoperative cholangiography.
– Endoscopic retrograde cholangiopancreatography
(ERCP).
– Magnetic resonance cholangiopancreatography
(MRCP).

12. Percutaneous transhepatic
cholangiography (PTC)
• The dye is injected through the skin into the
bile ducts within the liver (intrahepatic biliary
ducts).
• This is done using ultrasound to guide where
the needle goes.

13. Intraoperative cholangiography.
• The dye is injected directly into the bile duct
during a gallbladder operation.

14. Endoscopic retrograde
cholangiopancreatography (ERCP).
• The dye is injected into the common bile duct
and the pancreatic duct through a catheter
that’s passed down an endoscope.
• The endoscope is a thin, flexible lighted tube
that is gently passed down your throat and
through your stomach, until it reaches the
duodenum.

15. Magnetic resonance
cholangiopancreatography (MRCP)
• Magnetic resonance
cholangiopancreatography is a relatively new
technique for viewing the bile ducts, the
pancreatic duct and the gallbladder.
• Unlike the other techniques mentioned here,
no contrast medium has to be administered
for MRCP.
• It uses magnetic resonance imaging (MRI) to
produce detailed pictures.

16. Magnetic resonance
cholangiopancreatography (MRCP)

17. • Irrespective of how it is introduced, once the
dye is in the bile ducts, it can spread into the
whole biliary drainage system.
• Then X-rays can be taken to show up any
narrowing or blockages in the drainage
system.
• The resulting radiographic record is called a
cholangiogram.