Right upper abdominal pain and mild obstructive jaundice.
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There is an hyperdense nodular lesion obstructing the distal choledochal duct and promoting severe dilatation of the biliary tree and the gallbladder. Some small foci of pneumobilia are noted scattered through the distal intra-hepatic ducts. A duodenal diverticulum is present in the second portion of the duodenum.
This case was managed as a distal obstructive choledocholithiasis.
A differential diagnosis to be considered, and easily excluded in this case, is the ampular carcinoma, which usually arises from a distal position, at the pancreaticobiliary junction, and has low attenuation.