Chronic choledocholithiasis

Case contributed by Dr Michael P Hartung

Presentation

Transient elevation of liver function enzymes with abdominal pain.

Patient Data

Age: 95
Gender: Female
CT

Presentation

Heterogeneous hepatic perfusion on late arterial phase imaging. Moderate dilatation of intrahepatic ducts. Dilated common bile duct with abrupt taper to an oval filling defect in the distal common bile duct. No attenuation difference between late arterial and portal venous phase imaging. Hydropic gallbladder with dependent sludge or stones. No pericholecystic inflammation. No pancreatic ductal dilatation.

Ultrasound

2 years previously

Dilated gallbladder primarily filled with sludge and small stones. Common oval, nonshadowing, echogenic filling defect within the nondilated common bile duct.

Case Discussion

This patient underwent ultrasound 2 years prior to the CT, demonstrating findings consistent with choledocholithiasis or polyp in the common bile duct. Given the patient's advanced age (90) and lack of laboratory abnormalities, no further intervention was performed at that time.

The patient then presented with abdominal pain and transaminitis, which was improving at the time of imaging. On the CT, there is heterogeneous hepatic perfusion in the late arterial phase, which is likely related to resolving biliary obstruction/inflammation. The oval filling defect in the distal common bile duct with the same shape and dimension has finding on ultrasound can again be seen, and likely resulted in intermittent obstruction of the common bile duct.

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Case information

rID: 59556
Published: 14th Apr 2018
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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