Follow-up sonographic studies of five infants whose initial sonograms had displayed evidence for the diagnosis of cholelithiasis demonstrated spontaneous resolution of the gallbladder defects. These defects may have been caused by tumefactive sludge with acoustic shadowing. Whether sludge or gallstones are being imaged, in the absence of other clinical or imaging evidence of biliary tract disease, conservative (i.e., nonsurgical) management and serial sonograms are recommended.

Two hundred and one biopsies of the pancreas and/or extrahepatic bile ducts were performed in 173 patients using primarily ultrasound (US) or fluoroscopic guidance. Computed tomographic (CT) guidance was used twice. The success rate for detecting malignancy was 82.4%. Patients with primary ductal carcinoma had the lowest success rate. Seven complications occurred: five vasovagal reactions, one fever, and one acute pancreatitis in a patient with a normal variation, which resembled a mass. In this large series, aspiration biopsy of the pancreas and extrahepatic bile ducts proved to be a safe and reliable procedure that often can be performed on an outpatient basis. Fluoroscopic and US guidance are satisfactory for the majority of biopsies. CT guidance probably should be reserved for patients who undergo a repeat biopsy, or when US fails to adequately demonstrate the pancreas.

No abstract

Ultrasound is a well-established method of evaluating bile duct size, with accuracy rates ranging from 86 to 93%' Reasons for false-negative interpretation in cases of obstructive jaundice include lack of ductal dilatation in the presence of a common duct stone, sclerosing cholangitis, tumor encasement of the ducts (either from metastatic or cholangiocarcinoma), ducts filled with "debris," and technical difficulties often related to prior surgery in the area.'-4 This case report illustrates another cause of false-negative interpretation that is becoming increasingly important as the use of interventional procedures increases, namely, hemobilia in which clot fills a large portion of the ductal system and obscures its normally bile-filled lumen. CASE REPORTA 73-year-old black male presented with right upper quadrant pain, fever, and weakness. He was clinically icteric, and admission laboratory studies showed a total bilirubin level of 9.2 mg and alkaline phosphatase greater than 350 mg Ulliter. His history included surgery 46 years ago for adenocarcinoma of the stomach, with a recurrence at the stump 2 years prior to admission requiring a total gastrectomy. Cholecystectomy was performed 12 years previously for an uncomplicated cholecystitis. A common duct stone was diagnosed the year prior to this admission. The stone was partially dissolved chemically with monooctanoin and removed percutaneously.On this admission, the initial ultrasound examination showed a distal common duct measur-

No abstract