Obstructing choledochocele: diagnosis by endoscopic ultrasound

A case of choledochocele mimicking choledocholithiasis on MR cholangiography: A new differential diagnosis of pseudo-filling defect

We present the case of a 79-year-old female with acute cholangitis and cholecystitis who presented with right upper quadrant pain. Thin-collimation MR cholangiogram showed a filling defect measuring 1 cm, which was less prominent on single-slab images. Endoscopy showed dynamic ballooning and collapsing of the ampulla of Vater, and a cholangiogram showed characteristic bulging at the distal common bile duct, which led to the diagnosis of choledochocele. It is important to differentiate choledochocele as a cause of filling defect of the lower common bile duct on the MR cholangiogram.

Choledochocele demonstrated on conventional sonography

Choledochocele is the least common form of choledochal cyst. We report a rare bile duct cyst diagnosed in a 63-year-old woman via CT cholangiography. Although conventional sonography initially failed to reveal abnormal findings, a subsequent detailed study clearly depicted the lesion. To the best of our knowledge, this is the first report of choledochocele unambiguously demonstrated on transabdominal sonography.

Choledochocele imaged with magnetic resonance cholangiography

Choledochal cysts are rare developmental malformations of the biliary tree. Percutaneous and endoscopic ultrasound, as well as endoscopic retrograde cholangiopancreatography, are recommended diagnostic tools. Magnetic resonance cholangiography may also contribute to the workup and treatment plan of patients with choledochal cysts. We report a 25-yr-old white woman with episodic nausea and moderate epigastric discomfort. Magnetic resonance cholangiography showed a rather spherical, cyst-like, fluid-filled structure in continuity with the prepapillary segment of the common bile duct, thus making a choledochocele (type III choledochal cyst) likely. The patient was treated by endoscopic sphincterotomy and, after a 6-month follow-up, is without complaints.