In an effort to differentiate between obstructive jaundice and hepatocellular jaundice in which the clinical and laboratory findings do not clearly differentiate between the 2, the technique of percutaneous transhepatic cholangiography combined with needle biopsy of the liver was utilized. Forty procedures were performed with correct diagnosis being established in 38 and the correct diagnosis being missed on 2 occasions. Out of the 38 diagnosed correctly, a biliary radical was entered in 30 instances with roentgenograms then giving the site of obstruction. In 10 instances a biliary radical was not entered and 8 of these proved to be of hepatocellular origin, verified by needle biopsy of the liver. In 2 of this latter group in which a biliary radical was not entered, needle biopsy of the liver did not show hepatocellular damage and subsequent surgery demonstrated obstructive jaundice that had been missed by these procedures. Of the 40 procedures performed 28 were done with no complications; there was transient pain necessitating one injection of meperidine in 8 instances and in 4 instances a localized bile peritonitis developed that required immediate surgery for decompression of the biliary tree. All of these patients survived. It is felt that if the proper precautions are taken and the procedure done in the way outlined, that this is a safe procedure and is deserving of inclusion in our armementarium in the differential diagnosis of jaundice.