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The clinical significance of common bile-duct dilatation in patients without biliary symptoms or causative lesions on ultrasonography

Affiliation

  • 1 Division of Gastroenterology, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Korea.
  • PMID: 11437042
  • DOI: 10.1055/s-2001-15088

The clinical significance of common bile-duct dilatation in patients without biliary symptoms or causative lesions on ultrasonography

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Authors

Affiliation

  • 1 Division of Gastroenterology, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Korea.
  • PMID: 11437042
  • DOI: 10.1055/s-2001-15088

Abstract

Background and study aims: Although abdominal ultrasonography (US) is a good initial screening method for detection of biliary tract disease, we sometimes encounter patients who only have findings of dilatation of the common bile duct (CBD) on US, without specific biliary symptoms or jaundice. This study aimed to evaluate the causes and clinical significance of dilatation of the CBD in patients without biliary symptoms, jaundice, or causative lesions at US.

Patients and methods: A total of 77 patients who had no biliary symptoms and whose internal CBD diameter was more than 7 mm, without definite causative lesions on US, were enrolled. Of these, 49 underwent endoscopic retrograde cholangiopancreatography (ERCP) and 28 underwent follow-up US or computed tomography (CT) instead of ERCP. We excluded patients whose bilirubin level had increased beyond the upper normal level or who had previous history of upper abdominal surgery including cholecystectomy.

Results: The ERCP findings were as follows: no lesion in 20 patients (40.8%), juxtapapillary duodenal diverticulum (JDD) in 11 (22.5%), benign stricture in ten (20.4%), distal CBD mass in two (4.1%), choledochal cyst in two (4.1%), anomalous union of the pancreaticobiliary duct (AUPBD) in two (4.1%), and choledochal cyst with AUPBD in two (4.1%). There were no differences in age or in alkaline phosphatase or gamma-glutamyl transpeptidase (GGT) levels between the patients who had causative lesions revealed at ERCP and those who did not. Among the 28 patients who did not undergo ERCP, 12 had returned to normal and eight had no change in CBD diameter on follow-up US. Among eight patients who underwent CT, there were four with normal findings, one with JDD, and three with suspected choledochal cysts.

Conclusions: We detected a significant number of causative biliary tract lesions in asymptomatic adults with dilatation of the CBD on routine abdominal US; no laboratory or demographic parameters were useful for discrimination. Further diagnostic study will be helpful for the early diagnosis of biliary tract disease in such patients.

We detected a significant number of causative biliary tract lesions in asymptomatic adults with dilatation of the CBD on routine abdominal US; no laboratory or demographic parameters were useful for discrimination. Further diagnostic study will be helpful for the early diagnosis of biliary tract dis …

Bile duct dilatation (differential)

Bile duct dilatation can be due to several etiologies.

On this page:

Clinical presentation

Variable, depending on underlying cause, but usually:

  • right upper quadrant pain
  • jaundice
Radiographic features
Ultrasound

Harmonic imaging is useful when assessing the biliary system, as it improves the clarity of the lumen.

  • intrahepatic bile ducts
    • >2 mm
    • >40% of adjacent portal vein
  • extrahepatic bile ducts (common hepatic duct and common bile duct)
    • usually measured in the proximal duct, near the proper hepatic artery
    • diameter measured from inner wall to inner wall
    • >6 mm +1 mm per decade above 60 years of age
    • >10 mm post-cholecystectomy 2
  • It is common practice to refer to the common hepatic/bile duct as the common duct (CD) when reporting ultrasound, as the confluence of the cystic duct with the common hepatic duct (CHD) to form the common bile duct (CHD) is often not clearly defined.

Focal dilatation may be a result of downstream stricture, or damage to the elasticity of that segment of bile duct, possibly from prior stone passage.

Color Doppler can be useful to ensure that dilated structures in the liver are actually bile ducts and not an intrahepatic vascular malformation.

Differential diagnosis

The second thing to establish is which part of the biliary system is dilated:

  • intrahepatic
  • extrahepatic
  • intrahepatic and extrahepatic

Bile duct dilatation can be due to several etiologies. Clinical presentation Variable, depending on underlying cause, but usually: right upper quadrant pain jaundice Radiographic features Ultrasound Harmonic imaging is useful when assessin…