Radiolucent gallstones

Case contributed by Dr Vitalii Rogalskyi

Presentation

Sudden onset of right upper quadrant pain and jaundice. Rule out of gallstones or pancreatic tumor.

Patient Data

Age: 60 years
Gender: Female
CT

CT abdomen

Biliary duct dilatation up to distal part of common bile duct with no visible stones. The pancreas is unremarkable without signs of tumor or ectasia of the duct of Wirsung.

A hepatic cyst is noted at each lobe, larger on the right lobe. 

Left renal angiomyolipoma noted (contains macroscopic fat).

CT

Bile duct dilatation without visible problem.

So, CT shows no gallstones disease or pancreatic head tumor. We decided to perform endoscopic retrograde cholangiopancreatography (ERCPG). 

Photo

ERCP

ERCP shows a lot of gallstones within the common bile duct.

Case Discussion

Acute right upper quadrant pain and fever are very suspicious for choledocholithiasis. But always remember about radiolucent gallstone which isodense to bile and may not be identified on X-ray or CT as in this case. 

So, if you don't see gallstones on CT you should use other options such as US, MRI or ERCP which are more sensitive for radiolucent calculi.

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Case information

rID: 66219
Published: 15th Feb 2019
Last edited: 19th Feb 2019
Inclusion in quiz mode: Included

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