Presentation
Elevated liver function tests and right upper quadrant pain.
Patient Data
Age: 40 years
Gender: Male
From the case:
Choledocholiathiasis with normal caliber common bile duct
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Subtle small rounded filling defects in the distal common bile duct. Diffuse mild enhancement of the normal caliber common hepatic and bile ducts. Small focal cystic dilation of the pancreas duct near the ampulla (of uncertain significance). The stones are easier to see with liver windows on coronal reformats. They can also be seen on the axial images, making the common bile duct blend in with the pancreatic parenchyma.
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Small stones in the distal common bile duct confirmed by ERCP, removed by balloon sweepage (not shown).
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Stones best seen on coronal reformats with liver windows.
Case Discussion
Teaching points:
- choledocholithiasis can be diagnosed with CT - liver windows help to see the stones
- mild cholangitis may serve as a hint (as in this case), evidenced by mild diffuse enhancement of the walls
- you can still have choledocholithiasis with normal caliber bile ducts
- check the liver function tests when reading the CT to determine your degree of suspicion; these stones were detected because of careful evaluation after finding out the bilirubin was elevated (they are admittedly quite subtle)
- this patient does NOT need and MRCP - they can go right to ERCP