Choledocholithiasis

Case contributed by Dr Mostafa El-Feky

Presentation

Jaundice.

Patient Data

Age: 80 years
Gender: Male

Abdomen

CT

The gallbladder is distended with large hyperdense fundal stone and a less dense neck stone.

Mild intrahepatic biliary radicals dilatation. 

Dilated common bile duct with no visualized hyperdense stones identified on CT basis.

MRCP

MRI

Multiple small hypointense signal structures of less than 5 mm at the distal segment of the dilated common bile duct, consistent with biliary stones (choledocholithiasis). This is associated with mild central intrahepatic biliary radicals dilatation.

The gallbladder is distended with two intraluminal stones, a larger one at the fundus and a smaller one at the neck region (cholecystolithiasis). 

Branch type intraductal papillary mucinous neoplasm (IPMN) of the pancreas is noted at the body segment anteriorly.

The pancreatic duct is not dilated. No signs of pancreatitis.

Case Discussion

This case shows a large gallbladder stone and multiple CBD stones (choledocholithiasis) well seen on MRCP, which doesn't show up on CT (isodense stones). MRCP (MRI cholangiopancreatography) is a non-invasive MRI study of the biliary tracts. It has largely replaced ERCP as the gold standard for the diagnosis of choledocholithiasis. 3D reconstruction of heavily T2 sequence demonstrates a detailed anatomy of the biliary system.

Branch type intraductal papillary mucinous neoplasm (IPMN) of the pancreas is incidentally noted at the pancreatic body segment anteriorly. It is usually an incidental finding with low malignant potential compared to main duct type.

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.