Learning objectives
A practical and imaging facilitated approach to biliary duct dilatation will be presented to distinguish obstructive causes such as choledocolithiasis,
intraductal papillary mucinous neoplasms of the bile ducts (IPMN-B) and cholangiocarcinoma,
and non-obstructive causes such as Caroli disease,
choledochal cyst,
and primary sclerosing cholangitis (PSC).
Learning ojectives are:
To recognize that bile duct dilatation can be due to a myriad of benign and malignant etiologies,
where identification of diagnosis is key for timely diagnosis and management.
To highlight the importance of developing a systematic and...
Background
INTRODUCTION
Bile duct dilatation is due to a variety of benign and malignant etiologies where certain disorders require acute and emergent care,
thus it is important to have a systematic and thorough imaging approach.
Common and less common causes will be presented.
These include obstructive etiologies such as choledocholithiasis,
cholangiocarcinoma,
intraductal papillary mucinous neoplasm of the bile duct (IPMN-B),
and non-obstructive causes such as Caroli disease,
choledochal cyst or biliary cyst,
recurrent pyogenic cholangitis and primary sclerosing cholangitis.
Key features when evaluating a dilated bile...
Findings and procedure details
OBSTRUCTIVE CAUSES
1.
CHOLEDOCHOLITHIASIS
Choledocholithiasis is the presence of gallstones within bile ducts,
typically the common hepatic duct and the common bile duct.
It is termed uncomplicated,
when asymptomatic,
or complicated when presenting as acute pancreatitis or cholangitis.
Management involves removing the stones (endoscopically or surgically) and treating any associated complications such as liver abscess or septic thrombophlebitis.
Diagnosis and treatment has traditionally been with endoscopic retrograde cholangiopancreatography (ERCP),
however it is associated with complications such as pancreatitis and is operator and experience dependent.
Therefore,...
Conclusion
Intrahepatic biliary duct dilation is a common finding on imaging in patients with a variety of symptoms.
A systematic approach to the dilated bile duct is crucial,
as malignant conditions and diseases requiring urgent management should be considered.
Once excluded,
benign inflammatory conditions should be considered.
A first distinction is between obstructive (stone-based etiologies such as choledocolithiasis or stricture-based entities such as cholangiocarcinoma,
IPMN-B should be considered) and other miscellaneous conditions (such as post-inflammatory or inflammatory disorders) and non-obstructive biliary disorders (Caroli disease,
choledochal or...
References
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EUS vs MRCP for detection of choledocholithiasis.
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Arain MA,
Freeman ML.
Choledocholithiasis: Clinical manifestations,
diagnosis,
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3.
Peter E Darwin ASK,
Jennifer Lynn Bonheur.
Cholangiocarcinoma: Medscape; 2015.
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Cholangiocarcinoma: morphologic classification according to growth pattern and imaging findings.
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Imaging of...