A middle-aged woman presents with right upper quadrant abdominal pain and jaundice.

Fig. 19.1 (A–C) Axial contrast-enhanced CT images show dilatation of the intrahepatic bile ducts. There is a hyperdense stone (arrow) seen within the cystic duct associated with wall thickening. (D) Endoscopic retrograde cholangiopancreatography image shows a smooth extrinsic mass effect on the common hepatic duct (arrow).

Mirizzi syndrome (partial obstruction of the common hepatic duct due to a gallstone impacted in the cystic duct)

• Cystic duct stones
  
• Other causes of extrinsic ductal obstruction at the porta
  
• Enlarged portal lymph nodes
  
• Rare cases of hepatic artery aneurysm
  
• Hepatic metastases