Common bile duct and cystic duct calculi

Case contributed by Dr Ian Bickle

Presentation

Right upper quadrant pain and fever. Deranged LFT's stated - details unknown.

Patient Data

Age: 75 years
Gender: Female

The gallbladder contains multiple stones of variable size.

Two CBD calculi - one in the mid and one in the distal duct.   Dilated CBD.

Two stones in the cystic duct - one at its origin and one close to the junction with the CHD/CBD.

Fluoroscopy

Two filling defects in the distal CBD and a dilated CBD. The mid duct stone on MRCP has migrated distally.

Case Discussion

The vast majority of patients with clinical concern of biliary colic will have a preceeding ultrasound.   The distal duct is often very difficult to observe well due to obscuration from bowel gas, as is the cystic duct.

In this case a proximal CBD stone and dilated CBD were observed on ultrasound.  MRCP prior to treatment with ERCP revealed a whole lot more than a single CBD stone and demonstrates the exquisite detail offered by MRCP, especially with a 3D volume sequence.

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