cbd in usg report

Goubault P, Brunel T, Rode A, Bancel B, Mohkam K, Mabrut JY. Low-phospholipid associated cholelithiasis (LPAC) syndrome: a synthetic review. J Visc Surg. 2019 Mar 25. [Medline].

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Anderloni A, Ballare M, Pagliarulo M, et al. Prospective evaluation of early endoscopic ultrasonography for triage in suspected choledocholithiasis: results from a large single centre series. Dig Liver Dis. 2014 Apr. 46(4):335-9. [Medline].

References

Dan DV, Harnanan D, Maharaj R, Seetahal S, Singh Y, Naraynsingh V. Laparoscopic cholecystectomy: analysis of 619 consecutive cases in a Caribbean setting. J Natl Med Assoc. 2009 Apr. 101(4):355-60. [Medline].

Her biliary tree is dilated with both intrahepatic and extrahepatic
biliary dilatation. Her CBD measured 11 mm. This is a pathologically
dilated CBD. In over 95% of young normal subjects the common bile duct
measures less than 4mm. In the presence of gallstones the CBD can measure
up to 7mm without implying obstruction. The CBD can also dilate in the
elderly secondary to degeneration in the ductal wall and reach diameters
of up to 9mm. The CBD can also change in size physiologically in relation
to meals. In this patient there were gallstones readily visible in the
lower CBD on ultrasound. A diameter of the CBD of over 10mm is definitely
abnormal and will suggest the presence of stones in the CBD. In assessing
the CBD for stones, if ductal stones are seen then stones are present. If
CBD stones are not seen then this does not mean that they are absent since
there is a significant rate of false negative results, partly related to
the presence of obscuring gas in the duodenum.

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The relationship to ‘pathology’ seen on imaging to ‘disease’ and
clinical symptoms is interesting. Gallstones are common and an incidence
in excess of 10% in the population is described. It is common to find
gallstones in an otherwise asymptomatic patient. My policy is to tell
patients that they have gallstones even if they have no symptoms, however
I am always concerned that patients will then develop symptoms. I am
always surprised how patients can have significant radiological pathology
and have so few symptoms. The patient had obvious gallstones, a thickened
gallbladder wall, biliary dilatation and many CBD stones and yet had only
itching with a history of itching. The story of painless jaundice would be
more suggestive of pancreatic malignancy or a drug reaction rather than
gallstones.

The appearances of the liver are unexplained. Ultrasound is good for
assessing focal liver disease. A common abnormal pattern is the
geographical echogenic appearance seen in fatty change of the liver.