Ultrasound of Choledocholithiasis (Common Bile Duct Stones)

What this episode covers

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! Instagram: https://www.instagram.com/Radquarters/ Facebook: https://www.facebook.com/Radquarters/ X (Twitter): https://twitter.com/Radquarters Reddit: https://www.reddit.com/user/radiologistHQ/ 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.