Cholelithiasis with biliary dilatation

Case contributed by Dr Derek Smith

Presentation

Four days RUQ pain, with jaundice, light stools and dark urine. Normally fit and well. No previous imaging.

Patient Data

Age: 35 years
Gender: Female

Unremarkable liver parenchyma. Patent hepatic vasculature.

Marked biliary dilatation, both intra- and extra-hepatic, with common bile duct (CBD) maximally measuring 12 mm.

Thin-walled gallbladder containing multiple calculi. No pericholecystic fluid.

Normal spleen.

No free fluid.

 

Numerous gallbladder calculi. No features of acute cholecystitis.

Marked biliary dilatation, with a tortuous common biliary duct maximally measuring 12 mm. No ductal calculi, although some low signal in the distal duct consistent with sludge. Normal caliber pancreatic duct.

Dilated biliary tree, but less dilated than on the MRCP. No filling defect identified. No further current intervention/treatment.

Case Discussion

Given the presence of gallbladder calculi and the dilated biliary tree, it is possible that a stone had passed prior to imaging. The sludge/debris seen in the distal CBD on the MRI was likely contributing to the obstruction since it was absent on the ERCP and the amount of biliary dilatation had decreased on the ERCP as well. Due to the potential of further episodes, the patient progressed to an outpatient cholecystectomy.

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