Presentation
Right upper quadrant pain and fever. Deranged LFT's stated - details unknown.
Patient Data
The gallbladder contains multiple stones of variable size.
Two CBD calculi - one in the mid and one in the distal duct. Dilated CBD.
Two stones in the cystic duct - one at its origin and one close to the junction with the CHD/CBD.
Two filling defects in the distal CBD and a dilated CBD. The mid duct stone on MRCP has migrated distally.
Case Discussion
The vast majority of patients with clinical concern of biliary colic will have a preceeding ultrasound. The distal duct is often very difficult to observe well due to obscuration from bowel gas, as is the cystic duct.
In this case a proximal CBD stone and dilated CBD were observed on ultrasound. MRCP prior to treatment with ERCP revealed a whole lot more than a single CBD stone and demonstrates the exquisite detail offered by MRCP, especially with a 3D volume sequence.