Retained calculi in aberrant cystic duct stump causing obstructive jaundice

Case contributed by Dr Chris O'Donnell ◉

Diagnosis certain

Presentation

Woman who is 20 weeks pregnant with obstructive jaundice. Dilated biliary tree on US ? choledocholithiasis. Past history of cholecystectomy performed 2 years previously.

Patient Data

Age: 30

Gender: Female

From the case: Retained calculi in aberrant cystic duct stump causing obstructive jaundice

MRI

Coronal 2D MRCP

Aberrant cystic duct entering the distal CBD containing 3 large, facetted, filling defects indicative of calculi causing extrinsic compression to the distal CBD and obstruction to the distal combined lumen.

From the case: Retained calculi in aberrant cystic duct stump causing obstructive jaundice

Ultrasound

multiple

Dilated intra and extra hepatic biliary tree but no cause is evident, inclduing no obvious calculi.

Case Discussion

MRCP is an excellent test for the invetsigation of obstructive jaundice as it does not rely on active contrast excretion (as does CT intravenous cholangiography) and provides multi-directional assessment of the bile ducts using the intrinsic T2 signal of bile. It is more diagnostic, the greater the degree of bile duct dilatation. No ionizing radiation in this pregnant woman is an added bonus.