Choledocholithiasis causing intrahepatic biliary duct dilation

Case contributed by Dr Subash Thapa


All over body itching.

Patient Data

Age: 60 years
Gender: Female

Coronal T2 weighted images show well defined hypointense areas of various sizes in the dependent portion of the body of the gallbladder. There is obstruction at the distal CBD with dilatation of the proximal CBD and intrahepatic biliary system. The hyperintense bile produces a "convex margin" at the site of obstruction which is fairly specific for "meniscus sign of choledocholithiasis".

Axial T2 weighted images show “target sign” in the distal CBD, representing a central hypointense filling defect surrounded by hyperintense bile.

Case Discussion

Choledocholithiasis can be differentiated from a tumor in most cases, as the calculi may have angulated contours depending on the location in the bile duct and they are almost completely surrounded by high-signal-intensity bile (target sign) 1. Whereas abrupt termination of the bile duct and the absence of typical signs of biliary lithiasis have a high correlation with extrahepatic cholangiocarcinoma.

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