0:01

So here we have another patient.

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She's 80 years old, female.

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History is elevated liver function

0:06

tests and etiology of this.

0:11

And so we'll start off with their T2-weighted

0:12

sequences in the axial and the coronal plane.

0:17

As we scroll downwards, the first thing

0:21

I notice is bile ducts are dilated.

0:23

Remember, normal bile ducts, in normal

0:25

intrahepatic bile ducts, you're really going to

0:27

struggle to see them on T2-weighted sequences.

0:29

And if you do see them, they'll be

0:31

less than 2 millimeters in diameter.

0:33

These ones are a little bit big, both on the

0:36

left hepatic lobe and the right hepatic lobe.

0:38

They join together.

0:40

And this is a patient

0:41

who's post-cholecystectomy.

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So the gallbladder's out.

0:43

This is the cystic duct over here.

0:46

Joining the common hepatic duct.

0:48

And, uh, as we go downwards,

0:50

let's magnify a little bit.

0:52

We go downwards from this, you

0:53

see the common bile duct here

0:54

filled with T2 hyperintense bile.

0:57

And right over here, we can see a nice round

1:00

filling defect inside the bile.

1:03

The common bile duct.

1:06

Okay, let's look at this in the coronal plane.

1:07

I like to sort of verify things

1:09

in at least one or two planes.

1:12

So here, beautifully, nice round filling

1:14

defect inside the common bile duct in

1:18

this patient who's post-cholecystectomy.

1:20

For completion, let's look

1:21

at the T1-weighted images.

1:23

That filling defect, there's a motion

1:24

here, but is relatively hypointense,

1:27

maybe even intermediate signal.

1:28

It's basically very, very tough to see on the

1:33

sequences and it's definitely not hyperintense.

1:37

We also did an MRCP sequence over here.

1:39

And so let's have a look at that

1:40

to see if that helps us in any way.

1:43

And this came out pretty good.

1:44

We see lots of dilated bile ducts,

1:46

intrahepatic biliary tree over here,

1:49

the common hepatic duct is dilated.

1:52

And the common bile duct is dilated

1:53

and contains this filling defect.

1:55

And so, you know, these findings are again,

1:58

compatible with choledocholithiasis of stone

2:02

within the common bile duct in this instance.

2:05

And I wanted to show this case

2:06

because stones in the bile ducts can

2:10

happen in sort of one or two ways.

2:11

They can happen because there were stones

2:13

in the gallbladder and then those stones

2:15

escaped from the gallbladder and went into the

2:17

biliary tree and now cause an obstruction.

2:20

In this instance, the patient is post

2:22

cholecystectomy, so no stones were

2:24

transferred over from the gallbladder

2:25

because the gallbladder is out.

2:27

Rather, this stone likely formed in situ

2:30

within the bile duct itself, and that can

2:32

also happen if there is relative bile stasis

2:36

for another reason that the biliary tree is

2:38

just not emptying adequately and over a period

2:41

of time, that can predispose the patient to

2:44

forming stones inside the bile ducts themselves.

2:47

And so here we do see a stone here resulting

2:50

in ductal dilatation, probably resulting

2:52

in the elevated liver function tests.

2:54

And this is something that would have

2:56

to be taken out via an ERCP procedure.