*40-year-old male with complaint of severe epigastric colicky pain since 3 days associated with nausea.
What is the most likely diagnosis?
Answer
Answer: Mirizzi syndrome
Case Discussion:
MR images and MRCP demonstrate findings that are consistent with acute cholecystitis (pericholecystic fluid, gall bladder wall thickening, round stone, biliary sludge within the lumen). The gall bladder neck stone is compressed within the biliary confluence and proximal CBD, with mild diffuse intrahepatic biliary dilatation (Mirizzi Syndrome).
The Mirizzi syndrome refers to an uncommon phenomenon which results in extrinsic compression of an extrahepatic biliary duct from one or more calculi within the cystic duct or gallbladder. It is a functional hepatic syndrome but can often present with biliary duct dilatation and can mimic other hepatobiliary pathologies such as cholangiocarcinoma.
Patients may present with recurrent episodes of jaundice and cholangitis. It can be associated with acute cholecystitis.
MRCP classically shows a large impacted gallstone in the gallbladder neck and dilated extrahepatic ducts which gradually taper to a normal common bile duct.
References:
1.Fulcher AS, Turner MA, Capps GW. MR cholangiography: technical advances and clinical applications. Radiographics. 19 (1): 25-41.
2.Menias CO, Surabhi VR, Prasad SR et-al. Mimics of cholangiocarcinoma: spectrum of disease. Radiographics. 28 (4): 1115-29.
3. Becker CD, Hassler H, Terrier F. Preoperative diagnosis of the Mirizzi syndrome: limitations of sonography and computed tomography. AJR Am J Roentgenol. 1984;143 (3): 591-6.