KEY FACTS
Terminology
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Cholangiolithiasis, hepatolithiasis, biliary calculi, common bile duct (CBD) stones
Imaging
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Most stones are highly echogenic with posterior acoustic shadowing
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Ultrasound is 1st-line imaging modality
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Most common in periampullary region/distal CBD
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ERCP: Radiolucent, faceted, or angular filling defects within bile ducts
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Gold standard is diagnostic and potentially therapeutic
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MRCP: Low-intensity filling defects within increased signal intensity bile ducts
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Very sensitive for detection of bile duct stones
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NECT: Attenuation of stones varies from less than water density, through soft tissue, to dense calcification
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Not very sensitive for detection of bile duct stones
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Top Differential Diagnoses
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Cholangiocarcinoma, ampullary mass
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Ascending cholangitis, recurrent pyogenic cholangitis, or parasitic infection
Pathology
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Passage of gallstones into biliary ductal system (more common) vs. de novo stone formation within ducts
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Can cause obstruction with subsequent ductal dilation
Clinical Issues
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Presentation: Right upper quadrant pain, pruritus, jaundice; however, may be asymptomatic
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May present with acute complication: Cholangitis, pancreatitis
Scanning Tips
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Most stones will be located in distal CBD; extra effort is required to evaluate entire course of CBD to level of pancreatic head
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Acoustic shadow can be enhanced by using higher frequency transducers or turning off compound imaging
- •
Gain set too high can obscure posterior acoustic shadowing
in the distal common bile duct (CBD) 
and gallbladder 
.
with posterior shadowing 
that is compatible with a stone is present within the CBD 
on this longitudinal US. The CBD is located anterior to the hepatic artery 
and the portal vein 
. The hepatic artery crosses in between the portal vein and CBD.Related posts:
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