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Demonstration of cavitated hepatic masses by "skinny needle" transhepatic cholangiography. The need for ultrasonic or computed tomography evaluation in obstructive jaundice.

A patient with cholestatic jaundice, ascending cholangitis and recent development of sepsis had an unsuspected intrahepatic abscess discovered by "skinny needle" percutaneous transhepatic cholangiography (PTC). Ultrasound and computed tomography (CT) evaluation were omitted in the work-up because of the clinical impression that the disease was almost certainly due to an obstructing calculus. The unsuspected cause of cholestasis was found by PTC but would have more easily been detected by other means, as a second similar case illustrates.