Choledocholithiasis

Case contributed by Dr Mostafa El-Feky

Presentation

Abdominal pain and mild jaundice. Given history of cholecystectomy years ago.

Patient Data

Age: 65 years
Gender: Female

MRCP

MRI

The common bile duct (CBD) is dilated, reaching 16 mm in diameter with multiple signal voids identified in its mid and lower portions, the largest one measures 13 mm. This is associated with mild intrahepatic biliary dilatation. Also noted in the cystic duct stump are two stones, measuring about 5 mm in average diameter. The pancreatic duct is not dilated.

Case Discussion

This case shows multiple CBD stones and cystic duct stump stones, coupled with mild intra-hepatic biliary back pressure changes, a long period after cholecystectomy. MRCP (MRI cholangiopancreatography) is non-invasive MRI study of the biliary tracts. It has largely replaced ERCP as the gold standard for diagnosis of choledocholithiasis. It has the advantages of having no ionizing radiation, no intravenous contrast or complication rate inherent in ERCPs. 3D reconstruction of heavy T2 sequence gives easy examination of the biliary system from different views.

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