Intrahepatic biliary stone

Case contributed by Mostafa Elfeky
Diagnosis almost certain

Presentation

Right hypochondrium pain and raised serum bilirubin level. History of cholecystectomy with choledochojujenustomy.

Patient Data

Age: 60 years
Gender: Male

MRCP

mri
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Coronal
T2
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Axial
T2
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Axial T2
fat sat
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Axial Heavily
T2 - thin cuts
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3D volume
rendering T2 - MIP
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Info

Sizable intrahepatic stone (5.5 x 3 cm) casting and extending into the central aspects of the right and left biliary ducts branches bilaterally more marked on the left side associated with marked bilateral intrahepatic biliary dilatation, extending to the common hepatic duct reaching the choleducojujenostomy.

Status post cholecystectomy.

Multiple bilateral renal small simple cysts.

Case Discussion

Features are consistent with large intrahepatic biliary stone with central intrahepatic biliary obstruction. It is a rare condition and most commonly located in large-caliber ducts.

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