Presentation
Right upper quadrant pain. Abnormal LFTs.
Patient Data
Small liver cysts.
Prominent CBD.
No stones in the gallbladder or CBD.
The gallbladder is packed with stones.
Dilated CBD with several stones in the mid and distal duct.
Simple cysts in the liver.
Case Discussion
There is nothing worse in the field of medicine than a false negative - it helps nobody.
There is a growing trend for low threshold imaging requests and minimal vetting of requests (a debate in itself), in particular with vast amounts of CT imaging. This is aside from the high radiation doses involved.
Gallbladder disease is typically best seen on good old ultrasound.
MRI for interrogating the distal CBD comes a second best.
CT as this case demonstrates is a minefield of unpredictability.
There is no tiny suggestion of any stones on the CT, but wow look at the MRI.
The best test is always the right test.
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