Grey-scale ultrasonography was performed without access to detailed clinical information in a prospective study of 55 jaundiced patients. Forty-one were eventually proved to have an extrahepatic obstructive cause, and 14 had intrahepatic "medical" disease. Satisfactory ultrasound images were obtained in 54 patients, and the bile duct calibre was correctly reported in 53 (96%). All 14 medical cases were correctly identified. Two patients with gallstones (one with a normal sized duct) were incorrectly classified as medical. A specific and correct disease diagnosis was given in five of the 14 medical cases (one metastases, four cirrhosis), and in 23 of the 41 obstructive cases (12/14 pancreatic cancer, 5/15 gallstones), 5/5 bile duct compression, 1/3 bile duct cancer. Ultrasonography is safe, cheap, and acceptable to patients. It should be the first imaging investigation in jaundiced patients, providing remarkable diagnostic accuracy and important guidance for further management.
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