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.