Radiology Lectures | Radquarters

Ultrasound of Choledocholithiasis (Common Bile Duct Stones)

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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

    Click the YouTube posts tab or follow on social media for bonus teaching material posted throughout the week!

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    Spotify: https://open.spotify.com/show/1fnqomovit3QxvS0uvPDBP?si=918edad8f340434a

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

    The post Ultrasound of Choledocholithiasis (Common Bile Duct Stones) appeared first on Radquarters.

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    Radiology Lectures | RadquartersBy Daniel J. Kowal, MD
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