Imaging in biliary obstruction
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《英国医生杂志》
1 Department of Nuclear Medicine, Princess Royal University Hospital, Orpington, Kent BR6 8ND adrian.thomas@btinternet.com
Mrs Prior was referred for ultrasonography after identification of abnormal liver function.1 Imaging of the liver and biliary tree is a common problem, and advances in ultrasonography, computed tomography, and magnetic resonance imaging have improved our diagnostic ability.2 Ultrasonography is the first investigation for suspected biliary disease. This patient's scan showed stones in the gall bladder and in the lower common bile duct. Ultrasonography should be available with only a short wait for more urgent cases.
Her biliary tree is dilated with intrahepatic and extrahepatic biliary dilatation, and the common bile duct measured 11 mm. In over 95% of healthy people the diameter of the common bile duct is less than 4 mm. In patients with gall stones it can measure up to 7 mm without implying obstruction. The common bile duct can also dilate in elderly people secondary to degeneration in the ductal wall, reaching diameters of up to 9 mm, and change in size physiologically in relation to meals.
Mrs Prior had gall stones readily visible in the lower common bile duct on ultrasonography. However, even if the stones had not been visible, a diameter of over 10 mm would suggest their presence. Ultrasonography often fails to detect stones in the common bile duct, partly because of the presence of obscuring gas in the duodenum.3
The ultrasonogram also showed a swollen pancreas. Enlargement of the pancreas may have various causes, and if a stone is lodged in the distal common bile duct the patient may develop pancreatitis with pancreatic enlargement. The liver abnormalities were unexplained and caused concern. However, computed tomography excluded any disease.
Gall stones are common, with an incidence over 10% in the population. They are often found in patients who have no symptoms of gallbladder disease. In fact, patients can have appreciable radiological pathology with few if any symptoms. Mrs Prior will probably have had her stones for some time.(Adrian M K Thomas, consul)
Mrs Prior was referred for ultrasonography after identification of abnormal liver function.1 Imaging of the liver and biliary tree is a common problem, and advances in ultrasonography, computed tomography, and magnetic resonance imaging have improved our diagnostic ability.2 Ultrasonography is the first investigation for suspected biliary disease. This patient's scan showed stones in the gall bladder and in the lower common bile duct. Ultrasonography should be available with only a short wait for more urgent cases.
Her biliary tree is dilated with intrahepatic and extrahepatic biliary dilatation, and the common bile duct measured 11 mm. In over 95% of healthy people the diameter of the common bile duct is less than 4 mm. In patients with gall stones it can measure up to 7 mm without implying obstruction. The common bile duct can also dilate in elderly people secondary to degeneration in the ductal wall, reaching diameters of up to 9 mm, and change in size physiologically in relation to meals.
Mrs Prior had gall stones readily visible in the lower common bile duct on ultrasonography. However, even if the stones had not been visible, a diameter of over 10 mm would suggest their presence. Ultrasonography often fails to detect stones in the common bile duct, partly because of the presence of obscuring gas in the duodenum.3
The ultrasonogram also showed a swollen pancreas. Enlargement of the pancreas may have various causes, and if a stone is lodged in the distal common bile duct the patient may develop pancreatitis with pancreatic enlargement. The liver abnormalities were unexplained and caused concern. However, computed tomography excluded any disease.
Gall stones are common, with an incidence over 10% in the population. They are often found in patients who have no symptoms of gallbladder disease. In fact, patients can have appreciable radiological pathology with few if any symptoms. Mrs Prior will probably have had her stones for some time.(Adrian M K Thomas, consul)