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Age: 62

Sex: Male

Indication: Right upper quadrant pain

Sonographic Murphy sign: Negative

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Case #6


Findings

  • Dilated common bile duct, measuring up to 11 mm in diameter, with a 4 mm calculus in the distal common bile duct
  • Multiple echogenic gallstones and layering sludge in the gallbladder
  • Mild gallbladder distension with diffuse gallbladder wall thickening and trace pericholecystic fluid
  • Diffusely increased hepatic parenchymal echogenicity with smooth surface contour
  • Several nonobstructing left renal calculi. Kidneys are otherwise normal in appearance
  • Normal appearance of the spleen and of the visualized portion of the pancreas


Diagnosis

Biliary obstruction

Sample Report

Dilated common bile duct, measuring up to 11 mm in diameter, with a 4 mm calculus in the distal common bile duct

Multiple echogenic gallstones and layering sludge in the gallbladder. Mild gallbladder distension with diffuse gallbladder wall thickening and trace pericholecystic fluid, which likely relate to common bile duct obstruction.

Hepatic steatosis.

Nonobstructing left nephrolithiasis.


Discussion

  • In most patients, ultrasound is very sensitive for detecting biliary duct dilation, but the distal common bile duct and ampulla are often difficult to evaluate due to overlying bowel gas
  • If an explanation for biliary duct dilation is not identified by ultrasound, further imaging with contrast-enhanced CT or MRCP should be pursued
  • As a general rule, the common bile duct should measure less than 6 mm in diameter in adults (even allowing for age-related dilation), but may normally expand in the postcholecystectomy state


Images

Echogenic gallstone in the common bile duct (red arrow) with upstream extrahepatic biliary duct dilation.

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