Case contributed by Bruno Di Muzio
Diagnosis almost certain


Right upper abdominal pain and mild obstructive jaundice.

Patient Data

Age: 92-year-old
Gender: Female

CT Abdomen


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. 

Case Discussion

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. 

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