Choledocholithiasis

Case contributed by Dr Ian Bickle

Presentation

Right upper quadrant pain. Clinician professes to feel a mass in the right upper quadrant. Obstructive LFTS. No prior ultrasound.

Patient Data

Age: 70 years
Gender: Female
CT

Thin-walled gallbladder containing multiple small stones.

The CBD is dilated measuring 1.2cm.   Mild intrahepatic duct dilatation.

6mm stone in the distal CBD just above the ampulla of Vater.

Small renal cortical cysts.

Case Discussion

CBD stones can be observed on CT but it isn't the preferred modality.

In an ideal situation, ultrasound should be the first imaging investigation for painful jaundice to assess for gallstone disease.

MRCP may then be used if required prior to ERCP.

For painless jaundice ultrasound is also often indicated first with CT the most likely next investigation.

Vetting of imaging requests remains a noble, but unpopular, sport!

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Case information

rID: 60356
Published: 20th May 2018
Last edited: 14th Aug 2019
Tag: ripas2
Inclusion in quiz mode: Included

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