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Case of the Week 33 2015

*77-year-old patients with right upper quadrant pain.

What is the most likely diagnosis?

Answer

Answer: Cholelithiasis and choledocholithiasis

Case Discussion:

Ultrasound and Doppler ultrasound images showed dilated biliary tree. Axial T2 Fat Sat, coronal T2 and coronal MRCP images demonstrated filling defects in the dilated common bile duct, the cystic duct and the gallbladder.

Cholelithiasis refers to the presence of gallstones within the gallbladder. Choledocholithiasis denotes the presence of gallstones within the bile ducts. Choledocholithiasis is a not rare complication of cholelithiasis. Patients can present with right upper quadrant pain, jaundice, cholecystitis/cholangitis.

Ultrasound imaging can be useful for detecting stone(s) and dilated bile duct. Filling defects are seen within the biliary tree on MRCP.

References:
1. Attasaranya, S., Fogel, E., & Lehman, G. (2008). Choledocholithiasis, ascending cholangitis, and gallstone pancreatitis. Medical Clinics of North America 92, 926-960.
2. Gallstones. (2010, February 23). National Digestive Diseases Information Clearinghouse (NDDIC).