GI Radiology > Biliary > Bile Ducts > Inflammatory > Stones

Inflammatory Diseases of Bile Ducts

Choledocholithiasis

  1. Pathogenesis:
  • One of the most common causes of biliary disease, such as obstruction and infection.
     
  • Stones usually form in the gallbladder and may reach the common bile duct by passing through the cystic duct or by fistulous erosion through the gallbladder wall.
     
  • Many common duct stones lodge distally in the intrapancreatic portion of the common duct, producing pain, jaundice and elevated Liver Function Test (LFT).
     
  • Stones can form primarily within the ducts, usually due to bacterial deconjugation of bilirubin. This can also occur after cholecystectomy.
     
  1. Radiographic findings:
  • Cholangiography: single or multiple filling defects in the opacified biliary tree that move freely and change location with alterations in patient position.
  •                     
                Visible gallstones after injection           Visible occlusion by gallstones
      of contrast.                                                  after injection of contrast.

  • U/S: can image about 90% of proximal duct and 70% of distal duct stones.
     
  • Most common duct stones are echogenic structures that cast an acoustic shadow (about 10% do not shadow on U/S).

  • Transverse US image demonstrates
    echogenic, shadowing stones in CBD.

  • CT: may demonstrate characteristic target and crescent signs.

  • CT shows distal CBD stone (arrow) and
    surrounding dilated CBD causing the target sign.

  • Figures: Two different patients with multiple large stones within the extra hepatic bile ducts. Note multiple filling defects from CBD stones in (A)ERCP and (B)PTHC.
     

                 
A                                                                              B                                                        

 

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