Cocaine induced sphincter of Oddi dysfunction

Case contributed by Dr Jayanth Keshavamurthy

Presentation

Routine ultrasound for a patient with hepatitis C led to an order of MRCP.

Patient Data

Age: 65 years
Gender: Male

CBD dilated up to 1 cm smoothly.

No intra-hepatic dilation. No pancreatic duct dilation. No mass seen on post contrast images.

Common bile duct dilated smoothly both proximally and distally.

Case Discussion

The patient had a history of hepatitis C, but he was not a chronic alcoholic nor did he use opioids. He had no evidence of chronic pancreatitis. A routine ultrasound showed a common bile duct (CBD) dilated up to 0.8 cm. Due to the US, MRCP was ordered. There was no evidence of elevated bilirubin and alkaline phosphatase.

Nuclear medicine biliary scan was recommended but he has not kept his follow up for this study. This would have been a non-invasive confirmatory step.

Since the patient used cocaine and there was no mass on MRI/MRCP it was felt his dilated CBD was due to cocaine-induced sphincter of Oddi dysfunction.

These days radiologists need to know non-malignant etiologies for CBD dilation.

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Case information

rID: 71912
Published: 4th Nov 2019
Last edited: 2nd Dec 2019
Inclusion in quiz mode: Included
Institution: Augusta University

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