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choledocholithiasis AND MRCP

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ASGE guideline choledocholithiasis MRCP intermediate risk 2019

Main finding

The CT abdomen/pelvis shows a 6 mm calcified stone-like focus near the lower end of the common bile duct (CBD), close to the head of the pancreas.
This may represent a common bile duct stone, called choledocholithiasis. The report cannot be fully certain whether the calcification is inside the distal CBD or adjacent to it, hence the recommendation for MRCP.

Reassuring findings

  • No intrahepatic biliary dilatation (IHBR dilatation): the bile ducts within the liver are not enlarged.
  • No pancreatic duct dilatation, pancreatic mass, or abnormal pancreatic appearance.
  • Liver, spleen, kidneys, bowel, bladder, uterus, ovaries, and the visible vessels are reported as normal.
  • No ascites, enlarged lymph nodes, or free fluid.
  • The gallbladder is contracted, which can occur if the scan was done after eating and can make gallbladder assessment less informative.

What this means

A 6 mm CBD stone can sometimes pass on its own, but it can also intermittently block bile flow and cause:
  • Biliary colic: upper-right or upper-middle abdominal pain, often after meals
  • Jaundice: yellow eyes/skin, dark urine, pale stools
  • Infection of the bile ducts, called cholangitis
  • Pancreatitis
The absence of bile-duct dilatation is encouraging, but it does not completely rule out a clinically important CBD stone, especially if symptoms or liver blood tests are abnormal.

Recommended next step

Arrange the advised MRCP promptly through a gastroenterologist or treating doctor. MRCP is a noninvasive MRI examination that maps the bile and pancreatic ducts and can confirm whether there is truly a stone in the CBD. Guidelines commonly use MRCP or endoscopic ultrasound before ERCP when confirmation is needed, while ERCP is generally reserved for stone removal when a duct stone is established or strongly suspected (ASGE guidance summary).
Your clinician will usually also check:
  • Liver function tests: bilirubin, ALP, GGT, AST/ALT
  • Complete blood count and CRP if infection is possible
  • Serum amylase/lipase if there is significant upper abdominal pain or vomiting

Seek emergency care now if any of these occur

  • Fever or chills with abdominal pain
  • Yellowing of eyes/skin
  • Severe or persistent upper abdominal pain, especially radiating to the back
  • Repeated vomiting
  • Confusion, fainting, low blood pressure, or marked weakness
These can suggest bile-duct infection or pancreatitis and should not wait for an outpatient MRCP.
Overall, this is largely a normal CT with one potentially important finding: possible 6 mm distal CBD stone. The radiologist’s MRCP recommendation is appropriate.
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