What is the upper limits of normal for the diameter of the common bile duct?
>6 mm + 1 mm per decade above 60 years of age. This patient's CBD is not particularly dilated but it is always helpful to see the stone.
What are the other modalities to assess for choledocholithiasis if suspicion is high and the ultrasound is negative?
ERCP, MRCP or CT IVC.
Gallbladder contains several small calculi and there are are at least 3 similar sized small calculi in the lower common bile duct which has a maximum diameter of 7 mm.
The gallbladder itself shows only mild focal tenderness. There is no gallbladder wall thickening and there is no pericholecystic fluid.
The liver is unremarkable. Both kidneys appear normal. Spleen size is normal.
Conclusion.
Cholelithiasis and choledocholelithiasis. No good evidence of cholecystitis.