Choledocholithiasis with biliary obstruction and obstructive jaundice in a child with sickle cell anemia

Case contributed by Dr Mohammad A. ElBeialy

Presentation

A child with sickle cell anemia presenting with right upper abdominal pain and jaundice.

Patient Data

Age: 9 years
Gender: Male
  • The gall bladder is mildly distended with multiple small signal void gallstones. 
  • A few small signal void stones are seen within the distal common bile duct with associated mild dilatation of the CBD as ell as the intrahepatic biliary radicles. 
  • Mild hepatomegaly with diffuse low signal intensity of the liver and spleen; suggestive of secondary hemochromatosis that may be related to recurrent transfusions. 
  • The scanned bony spine and the pelvic bones show diffuse T2 hypointensity  indicative of red marrow reconversion or marrow hyperplasia consistent with chronic anemia (the marrow signal is even darker than what would be expected in the normal T2 FAT SAT. marrow signal). D12, L1 and L2 vertebrae show mild central end-plate depression as an early sign of H-Shaped vertebrae
  • Mild bilateral nephromegaly.    

Case Discussion

Choledocholithiasis with GB and CBD stones associated with mild dilatation of the CBD and intrahepatic biliary radicles, mild hepatomegaly with possible secondary hemochromatosis as well as mild bilateral nephromegaly in a child patient with sickle cell anemia. The case nicely demonstrates some of the early abdominal manifestations of sickle cell anemia.   

 

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