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.