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Case of the Month

September 2009

Patient Data: 85 year old female

Clinical Info: Raised bilirubin levels


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The common hepatic duct is filled with echogenic structures without acoustic shadowing


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The same structures are seen in the distal common bile duct


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Detail of the structures in the common bile duct


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Transverse image of the distal common bile duct at the level of the pancreatic head with an intraluminal structure.


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Longitudinal image of the gallbladder. The same structures are seen in the gallbladder The structures do not cause acoustic shadowing and represent inspisated bile or sludge. The sludge can clump together and form sludge balls. It can be difficult to differentiate inspisated bile from hemobilia. The patient history is usually the clue in differentiating these two. Also in some cases is can be difficult to differentiate inspisated bile from a soft tissue mass as can be found in patients with cholangiocarcinoma.


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The next case is a 55 year old female patient with jaundice. In this case the bile ducts are completely filled with echogenic material again without acoustic shadowing. In this case the bile ducts are completely filled with sludge and stones.


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Only on the detail image it is clear that it is not one tumor but multiple structures clumped together


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Detail of the bile duct with sludge and stones


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An ERCP and papillotomy confirmed the diagnosis in this case


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This longitudinal image of a choangiocarcinoma with a soft tissue mass in the common bile duct illustrates the resemblance with a sludge filled bile duct.

For more examples of bile duct stones sludge and tumors see section 1.2 gallbladder and bile ducts.


Copyright © Dr. T.S.A. Geertsma, Ziekenhuis Gelderse Vallei, Ede, The Netherlands. All rights reserved.

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