Biliary ascariasis

Discussion:

While the common bile duct stones mostly appear as discrete and round signal voids, biliary ascariasis, as expected, are seen as curvilinear tubular (live worm) or amorphous (dead worm) stuctures. In this case, they appear fragmented and amorphous with some well outlined thin curvilinear projections, consistent with dead worms.

Biliary ascariasis is still prevalent in many of the rural areas of developing countries. This patient had a similar background.  Also, it is common practice to prescribe Albendazole (anti-helminthic) frequently as empirical measure. Probably, this patient also received Albendazole during prior treatments.

Other differential would be choledocholithiasis.

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