ABSTRACT
The procedure is performed under ultrasound or CT guidance. A pigtail catheter is inserted into the cyst, and the cyst fluid aspirated. The fluid is usually clear and should be sent for cytology to exclude malignancy, culture to exclude infection, and microscopy to look for hydatid scolices. In addition the fluid should be assessed for the tumor marker CA19-9 which, if elevated, suggests an underlying diagnosis of cystadenoma or cystadenocarcinoma ( 30 ). Any bile staining of the fluid would suggest a communication with the biliary tree and would mandate abandoning the procedure and further assessment with cholangiography. The consequence of inadvertent injection of sclerosant into the biliary tree is devastating, and following cyst drainage a contrast cystogram should always be performed ( 28 ).
