The meniscus sign on cholangiography suggests impacted choledocholithiasis and is characterized by a concave cutoff of the lower common bile duct lumen. When a stone is impacted in the distal duct, fluid may not be visualized on the sides of the stone and therefore the contour of the duct terminus must be scrutinized to infer the shape of the obstructing lesion. A concave contour suggests a rounded filling defect as in a stone, in contrast to the tapering or abrupt cutoffs that may be seen with a normal ampulla of Vater or in benign or malignant strictures. The sign has been described with both ERCP (contrast filling up to the lower surface of the stone) and MRCP (fluid signal extending down to the upper surface of the stone) 1-8.
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