In this radiology lecture, we review the ultrasound appearance of choledocholithiasis (common bile duct stones)!

Key teaching points include:

• Choledocholithiasis = Stones within common bile duct (CBD)


• Seen in up to 15% of patients with cholelithiasis


• Clinical presentation: Asymptomatic, biliary colic, cholangitis, pancreatitis, jaundice


• On ultrasound, see rounded stone or stones in CBD


• Shadowing of stone less common than with cholelithiasis, twinkling artifact may help


• CBD dilatation defined as greater than 6 mm allowing for an additional 1 mm per decade above 60, or greater than 10 mm post-cholecystectomy.


• Intrahepatic dilatation and cholelithiasis may be present


• Sensitivity of US up to 40% for detecting CBD stones, but US accuracy 90% for detecting CBD dilatation


• If US negative and high clinical suspicious for choledocholithiasis, MRCP can be considered


• CT has reduced sensitivity with only 15-20% gallstones visible on CT


• Supportive lab values: Elevated serum bilirubin, alkaline phosphatase (ALP), and gamma-glutamyl transferase (GGT). AST and ALT may also be elevated, but less specific. Labs can even be normal in the setting of choledocholithiasis


• Tx may include endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy. Intraoperative cholangiogram during cholecystectomy

To learn more about the Samsung RS85 Prestige ultrasound system, please visit: https://www.bostonimaging.com/rs85-prestige-ultrasound-system-4

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This video is for informational purposes only. It does not replace the advice or counsel of a doctor or health care professional.

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