Dilatation of the common bile duct

Case contributed by Dr Bruno Di Muzio

Presentation

Epigastric abdominal pain for about 24 hours, associated with nausea and poor appetite. Previous history of gallstones.

Patient Data

Age: 69
Gender: Female

Ultrasound

Modality: Ultrasound

The patient was referred for sonographic evaluation in the emergency department.

Dilatation of common bile duct seen in its entire path to the head of the pancreas. Diameter of up to 1.5 cm. Were not identified parietal thickening or content within. Ultrasound showing normal pancreas and ectasia of the main pancreatic duct (Wirsung> 2 mm). The characterization of the gallbladder was difficult to ultrasound sometimes showing "wall-echo shadow complex."

Modality: CT

CT without contrast demonstrates the calculation of about 2.0 cm into the gallbladder and small focal calcification of its wall. It is also evident dilatation of the bile duct.

Case Discussion

The patient has increased canalicular enzymes. She was admitted for diagnostic investigation.

CT was performed without contrast due to changes in renal function of patients. It is subject to ERCP. There are symptoms compatible with biliary obstruction, but the obstructive factor was not identified. The stone within the gallbladder is unique and large (the study of CT), but one can not rule out choledocholithiasis (already eliminated?). Another hypothesis for the obstruction is possible neoplastic lesion in the common bile duct narrowing his portion in the pancreatic head / duodenal second portion.

Results not available to the sector of diagnostics.

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Case Information

rID: 18091
Diagnostic certainty: Certain
System: Hepatobiliary
Inclusion in quiz mode: Included

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