This site is targeted at medical and radiology professionals, contains user contributed content, and material that may be confusing to a lay audience. Use of this site implies acceptance of our Terms of Use.

Gas in biliary tree - CT cholangiography (false + ve bile duct strictures)

Case contributed by: Dr Chris O'Donnell

Presentation:

PH cholecystectomy. Now RUQ pain

Patient Data:

Age: 75

Gender: Female

From the case: Gas in biliary tree - CT cholangiography (false + ve bile duct strictures)

Modality: Ultrasound

Loading more images...

Echogenic focus with shadowing in bile ducts ? stone

From the case: Gas in biliary tree - CT cholangiography (false + ve bile duct strictures)

CT IVC

Modality: CT

Loading more images...

MIP of post IV Biliscopin scans suggest multiple bile duct strictures

IV Biliscopin infused over 30 minutes prior to scanning.

As in all reconstructed data sets on CT it is very important to review the source images - here the MIP looks like lots of bile duct strictures (sclerosing cholangitis or cholangiocarcinoma) but on the source axial scans, it is clearly due to the presence of gas displacing the contrast agent. Gas has entered the biliary tree via a very large duodenal diverticulum into whic the bile ducts enters disturbing the normal ampullary mechanism