what does a dilated cbd mean

Goals: A systematic review of studies on patients with dilated CBD was performed to identify etiologies and clinical factors that may predict which patients require further diagnostic testing and long-term outcomes. A PubMed search for relevant articles published between 2001 and 2014 was performed.

Results: The search yielded a total of 882 articles, and after careful individual review for eligibility and relevancy, 9 peer-reviewed studies were included. A cause of the CBD dilation was found on average in 33% of cases and the most common causes were: CBD stone, chronic pancreatitis, and periampullary diverticulum. The overall CBD diameter was not associated with finding a causative lesion. Coexisting CBD and intrahepatic bile duct dilation, age, and jaundice were found to be indicators of pathologic lesions. Dilation of both the CBD and pancreatic duct was suggestive of pancreatic disease, especially pancreatic malignancy in the setting of obstructive jaundice. Follow-up was reported in 6 studies ranging from 6 to 85 months, and generally there was no change in the diagnosis.

Background: With the widespread use of abdominal imaging, an incidentally found dilated common bile duct (CBD) is a common radiographic finding. The significance of a dilated CBD as a predictor of underlying disease and long-term outcome have not been well elucidated.

Conclusions: Incidentally found biliary tract dilatation can be a manifestation of significant biliary tract disease including malignancy. Long-term outcome is not well defined and further prospective studies examining the most cost-effective approach to evaluation are needed.

Her pancreas was seen to be swollen. The enlargement of the pancreas
may have various causes and if a biliary stone is lodged in the distal
CBD then the patient may develop pancreatitis. With aging, the pancreas
becomes more echogenic and atrophic on ultrasound.

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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.

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.

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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.

Her initial presentation was during a consultation made by her
husband. Her symptoms seem relatively minor yet the biochemistry results
are quite abnormal indicating a pattern of obstructive jaundice. Her
ultrasound findings are dramatic with stones seen in the gallbladder and
in the lower common bile duct (CBD). Ultrasound is the first-line
investigation for the gallbladder and biliary tree. The ultrasound scan
should be available with only a short wait for more urgent cases. This
patient should be prioritised for an urgent scan appointment.

What does a dilated cbd mean

Endoscopic biliary drainage is an established mode of treatment for acute cholangitis, having high success rates and low morbidity and mortality [6-8]. Recent advances in and utilization of endoscopic biliary tract drainage along with the administration of antimicrobial agents have contributed to a decrease in the number of deaths due to acute cholangitis. However, it remains a life-threatening disease unless biliary tract drainage is performed in a timely manner.

Conclusions

By univariate analysis, patients who developed cholangitis requiring emergent drainage were more likely to have dilated CBD (> 10 mm) at the first visit than were those who did not (P = 0.025) ( Table 5 ). By multivariate analysis too, CBD dilation was the only significant risk factor for the development of moderate or severe cholangitis among patients with silent bile duct stones (OR = 10.18, 95% CI: 1.09-94.73, P = 0.042) ( Table 6 ).

Table 3

Of 101 patients analyzed, 32 had moderate or severe cholangitis as the indication for emergent drainage, and the remaining 69 did not. Patients who required emergent drainage were more likely to have gallstones (P = 0.029), dilated CBD (> 10 mm) (P = 0.004) and larger CBD stones (P = 0.019). By multivariate analysis, CBD dilation was the only significant differentiating clinical characteristic of the patients who required emergent drainage (OR = 3.75, 95% CI: 1.41-9.96, P = 0.008). Of the 35 patients with silent bile duct stones, eight required emergent endoscopic drainage during the waiting period. CBD dilation was also the only significant risk factor for the development of moderate or severe cholangitis among patients with silent bile duct stones (OR = 10.18, 95% CI: 1.09-94.73, P = 0.042).

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