Mirizzi syndrome

Case contributed by Dr Mostafa Mahmoud El Feky

Presentation

Obstructive jaundice, fever, right hypochondrial pain.

Patient Data

Age: 80
Gender: Male
MRI

MRCP

The gallbladder is distended harboring biliary sludge as well as two stones, measuring 1.5 cm each. One of them is located in the gallbladder neck, exerting extrinsic compression on the biliary confluence, with moderate diffuse intrahepatic biliary duct dilatation (Mirizzi syndrome).

A 6.8 cm lesion is noted at segments IV/VIII, showing T2 hyperintensity and rim enhancement with surrounding hepatic hyperemia, and no central enhancement (hepatic cholangitic abscess).

MRI

Annotated images

The gall bladder neck stone is compressed within the biliary confluence and proximal CBD, with moderate diffuse intrahepatic biliary dilatation (Mirizzi Syndrome).

Case Discussion

Imaging features of this case are in keeping with calculous cholecystitis, with Mirizzi syndrome and hepatic abscess present. Low insertion of the cystic duct into the common bile duct is thought to be an anatomical risk factor. Mirizzi syndrome could be associated with recurrent cholangitis and in turn, the possibility of cholangitic abscess formation.

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Case information

rID: 53745
Case created: 4th Jun 2017
Last edited: 3rd Jul 2017
Inclusion in quiz mode: Included

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