Choledocolithiasis (CBD calculus)

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CBD Stone
Choledocolithiasis (CBD calculus)

Choledocfolithiasis ultrasound case study

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Reporting Panel

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CBD Pathology

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USG

Choledocolithiasis (CBD calculus) ultrasound case study

CASE–1

Clinical History

A 52-year-old patient presented with intermittent right upper quadrant abdominal pain, jaundice, and dyspepsia. There was no history of recent abdominal trauma. Ultrasound was performed for evaluation of suspected biliary obstruction.

Ultrasound Findings

Ultrasound examination demonstrates a dilated common bile duct measuring approximately >5 mm. An echogenic intraluminal focus measuring approximately 4.4 mm is identified within the distal common bile duct, producing posterior acoustic shadowing, consistent with a calculus. Mild intrahepatic biliary radicle dilatation is noted. The gallbladder may contain calculi without evidence of acute cholecystitis. No pericholecystic fluid is seen.

Report Line

Common bile duct is dilated, measuring approximately ____ mm in diameter. An echogenic calculus measuring approximately ____ mm is visualized within the distal common bile duct, producing posterior acoustic shadowing. Mild intrahepatic biliary ductal dilatation is present. No sonographic evidence of acute cholecystitis is identified. Sonographic features are suggestive of choledocholithiasis.

Impression

Features are consistent with choledocholithiasis with CBD dilatation.

Recommendation

Clinical and laboratory correlation including liver function tests is recommended. MRCP or endoscopic ultrasound (EUS) may be considered for further evaluation if required. ERCP is recommended for confirmation and therapeutic stone extraction when clinically indicated. Surgical consultation should be considered in appropriate clinical settings.

Key Learning Points

• Choledocholithiasis refers to the presence of one or more calculi within the common bile duct.
• Ultrasound findings include a dilated common bile duct with an echogenic intraductal calculus producing posterior acoustic shadowing.
• Intrahepatic biliary ductal dilatation commonly accompanies distal biliary obstruction.
• Gallstones are frequently associated with choledocholithiasis.
• Ultrasound may occasionally fail to detect small distal CBD stones due to overlying bowel gas.
• MRCP and endoscopic ultrasound provide excellent non-invasive evaluation when ultrasound findings are equivocal.
• ERCP remains the gold standard for both diagnosis and therapeutic removal of common bile duct stones.