Presentation
Right upper quadrant pain. Patient with two studies 3 years apart. First study is a CT Cholangiography. Second is CT abdomen when patient had recurrent symptoms.
Patient Data
Comparison made with previous study. Note cholecystectomy clips. 10mm ovoid filling defect seen within the proximal common bile duct at the level of the cystic duct is consistent with an intraductal calculus. Mild intrahepatic duct dilatation . The bile duct distal to the calculus is however enlarged measuring 14mm, with the possibility of a 2nd distal CBD calculus. Contrast is demonstrated passing into the duodenum. Note is made of the previous US report of a possible pancreatic head lesion, and although no definite lesion is identified in this study, a dedicated pancreas examination has not been performed.
Diffuse atheroma.
Visualized abdominal viscera are unremarkable.
Bibasal atelectasis with dependent changes.
Conclusion: 10mm proximal common bile duct calculus and possible 2nd distal CBD calculus, but without evidence of complete obstruction.
Post cholecystectomy with dilatation of the common bile duct measuring a maximum of 1.4 cm. Pneumobilia within the intrahepatic and common bile duct. Hypoattenuating filling defect present within a proximal small jejunal loop measuring 10 x 14 mm. No dilated small or large bowel loops. No intraperitoneal free fluid.
The spleen, adrenals, pancreas, uterus and urinary bladder are unremarkable. Hypodense lesions within the cortex of the left kidney most consistent with renal cysts, right kidney is within normal limits. No hydronephrosis or hydroureter. Calcified atheroma of the abdominal aorta.
Multilevel spinal degenerative change. No suspicious osseous abnormality.
Impression: Previous cholecystectomy. Dilatation of the common bile duct with associated pneumobilia and a filling defect present within a jejunal bowel loop suggestive of the recent passage of a stone from the common bile duct.
Case Discussion
Two studies, a CT IVC showing a calculus in the CBD. This study was followed by ERCP and stone extraction.
A later CT abdomen, when the patient had recurrent symptoms suggestive of biliary colic, shows air in the biliary tree associated with a stone in the jejunum.
Biliary calculi are rarely calcified, this patient has formed multiple bile duct stones, all non-calcified.
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