Choledocholithiasis (CT IVC)
Epigastric pain. Past history of papillary stenosis, treated with ERCP. US shows CBD = 12 mm.
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CT cholangiogram chosen as patient is not jaundiced, 100 ml Biliscopin infused over 30 minutes.
CT cholangiogram showing gas in the dilated biliary tree from previous sphicterotomy, and stones in lower dilated CBD.
CT cholangiography is a very useful examination for the detection of bile duct pathology if the serum bilirubin is less than 2x elevated. Beyond this level, the contrast agent is poorly excreted.