Intrahepatic biliary stones

Case contributed by Dr Mostafa Mahmoud El Feky

Presentation

Right hypochondrial pain.

Patient Data

Age: 45
Gender: Female
MRI

MRCP

The liver shows cirrhotic changes in the form of nodular contours and parenchymal dysmorphism, as well as widening of the interlobar fissure. No focal lesion in either T2 or diffusion images.

The intrahepatic portal branches show loss of signal void, suggestive of partial portal thrombosis. Periportal ill defined T2 hyper-intense signal is seen reflecting associated portal triad inflammatory changes.

Multiple intrahepatic biliary strictures with interrupted segments of dilatation, notably involving the right anterior duct reaching the capsule and harboring multiple stones around 4 mm. Normal configuration of the gall bladder with no luminal signal defects.

The spleen is mildly enlarged measuring 14 cm.

MRI

HASTE 3D Images

Multiple intrahepatic biliary strictures with signal voids representing intraductal stones.

Case Discussion

Intrahepatic biliary stones are rare; common location of stone is in large-caliber ducts mostly in left hepatic lobe or posterior segment of the right hepatic lobe. The intrahepatic biliary strictures may suggest primary sclerosing cholangitis. Biliary strictures are one of the causes of primary intrahepatic bile duct stones.

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Case information

rID: 54180
Case created: 25th Jun 2017
Last edited: 4th Jul 2017
Inclusion in quiz mode: Included

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