PTBD and stenting offer a safe and effective method in providing palliative treatment for patients with biliary obstruction. Patients likely to have high levels of morbidity and mortality can be predicted before PTBD, using a risk stratification score, highlighting the need for closer clinical observation and delayed stent placement.

This technique is safe and effective and is recommended for histological diagnosis during PTBD in patients with inoperable malignant biliary strictures. Diagnostic yield is greater when bilirubin levels are low and there is no sepsis; histological diagnosis by way of forceps biopsy renders cytological sampling unnecessary.

Malignant biliary obstruction is commonly due to pancreatic carcinoma, cholangiocarcinoma and metastatic disease which are often inoperable at presentation and carry a poor prognosis. Percutaneous biliary drainage and stenting provides a safe and effective method of palliation in such patients, thereby improving their quality of life. It may also be an adjunct to surgical management by improving hepatic and, indirectly, renal function before resection of the tumor.

Objective: Cystic renal masses are conventionally assessed by contrast CT and/or simple ultrasound scan. Contrast Enhanced Ultrasound (CEUS) is a relatively new investigation which may act as a novel tool for investigation of these masses and the aim of this study was to evaluate this potential. Patients and methods: 19 patients underwent CEUS in our Trust for investigation of complex cystic renal masses. The results were compared with other investigation modalities i.e. CT and simple ultrasound scans. Results: In nine patients, CEUS suggested a benign lesion. In six of these patients, contrast CT and/or simple ultrasound scan were inconclusive. Malignant cystic renal mass was diagnosed in nine patients by CEUS. In five of these patients, contrast CT and/or simple ultrasound scan were indeterminate. Three of the five patients had nephrectomy which confirmed malignancy in two and benign cystic nephroma in the third case. In one patient both simple ultrasound and CEUS were inconclusive whereas a contrast CT scan showed benign lesion. Conclusion: Within limitations of our study, CEUS provided information additional to conventional imaging in eleven patients. It appears to be a useful investigation in conjunction with conventional imaging for investigation of complex cystic renal masses but requires further evaluation.

CEUS is a viable and clinically safe method for increasing visualisation of the deep venous system. It has the potential to improve visualisation of the lower limb venous system, reducing follow-up costs and diagnostic uncertainty for patients and the clinician.