Mirizzi syndrome: on ultrasound
Acute onset of RUQ pain with two days of vomiting.
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Marked dilatation of the extra-hepatic billary tree. There is also a large stone located in the Hartman's pouch, with compression of the adjacent CBD.
Biliary sludge with thickened gallbladder wall.
No intrahepatic duct dilatation.
Isolated dilatation of the extra hepatic CBD with the presence of a large stone in the cystic duct or Hartman's pouch, with a clinical picture of acute cholecystitis, is highly suggestive of Mirizzi syndrome.