Cocaine induced sphincter of Oddi dysfunction

Case contributed by Jayanth Keshavamurthy
Diagnosis probable

Presentation

Routine ultrasound for a patient with hepatitis C led to an order of MRCP.

Patient Data

Age: 65 years
Gender: Male
Coronal
MRCP
Axial
T2
Coronal
T2
Axial
T1 C+
Axial
T1 C+
Axial late phase
(~10 mins)
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Info

CBD dilated up to 1 cm smoothly.

No intra-hepatic dilation. No pancreatic duct dilation. No mass seen on post contrast images.

Transverse
Transverse
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Info

Common bile duct dilated smoothly both proximally and distally.

Case Discussion

The patient had a history of hepatitis C, but he was not a chronic alcoholic nor did he use opioids. He had no evidence of chronic pancreatitis. A routine ultrasound showed a common bile duct (CBD) dilated up to 0.8 cm. Due to the US, MRCP was ordered. There was no evidence of elevated bilirubin and alkaline phosphatase.

Nuclear medicine biliary scan was recommended but he has not kept his follow up for this study. This would have been a non-invasive confirmatory step.

Since the patient used cocaine and there was no mass on MRI/MRCP it was felt his dilated CBD was due to cocaine-induced sphincter of Oddi dysfunction.

These days radiologists need to know non-malignant etiologies for CBD dilation.

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