Pseudotumor of the distal common bile duct at endoscopic retrograde cholangiopancreatography

Department of Radiology, University of California San Francisco, San Francisco, CA 94143-0628, USA.
Clinical imaging (Impact Factor: 0.81). 07/2011; 35(4):279-83. DOI: 10.1016/j.clinimag.2010.07.004
Source: PubMed


Prior studies have described a pseudocalculus appearance in the distal common bile duct as a normal variant at cholangiography. The objective of this study was to describe the occurrence of pseudotumor in the distal common bile duct at endoscopic retrograde cholangiopancreatography (ERCP).
Nine patients who underwent ERCP between May 2004 and July 2008 were identified as having a transient eccentric mural-based filling defect in the distal common bile duct. A single reader systematically reviewed all studies and recorded the imaging findings.
The mean diameter of the filling defect was 9 mm (range, 5 to 11). Eight patients had resolution of the filling defect during the same ERCP or on a subsequent ERCP, and in two of these patients the inferior border of the filling defect was not well visualized. The other patient underwent surgical resection of a presumed tumor with no evidence of malignancy on surgical pathology.
An eccentric mural-based filling defect in the distal common bile duct can be artifactual in nature and may reflect transient contraction of the sphincter of Oddi. Recognition of this pseudotumor may help avoid unnecessary surgery.

36 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: Magnetic resonance cholangiopancreatography (MRCP) is being used increasingly for noninvasive diagnostic evaluation of pancreatobiliary disease [1– 41]. This technique basically exploits the long T2 relaxation times of stationary or slow-moving nonhemorrhagic fluid and displays bile and pancreatic juices with a high signal intensity on T2-weighted images. Although MRCP images resemble images obtained with endoscopic retrograde cholangiopancreatography (ERCP), the underlying physics and principles are largely different. For radiologists and non-radiologists, it takes time to become familiar with the MRCP appearance of common and uncommon variants and pathologic conditions. In particular those who have extensive experience with ERCP initially may be disappointed when MRCP and ERCP images obtained in the same patient show different features. Initially, they may claim that MRCP “missed the disease.” After a learning curve of variable time, they may learn that the information is the same, but the presentation may be different. Further, they may understand that the capability to combine MRCP with unenhanced and dynamic multiphase contrast-enhanced cross-sectional magnetic resonance imaging (MRI) is unique and gives MRCP an unrivaled diagnostic potential [1]. We provide an overview of the different types of pitfalls in MRCP. Pitfalls related to the technique are those that have an obvious link with the underlying MR physics and are unique for MRCP. Pitfalls related to the intrinsic limitations of ductal imaging are shared by MRCP and ERCP and are caused by the fact that some diseases may present without ductal abnormalities, or may induce ductal changes only in a late stage. Moreover, ductal abnormalities may be aspecific, and correlation with findings at cross-sectional MRI may be mandatory. We also discuss the pitfalls related to anatomic variants and to specific diseases. Some of these are also encountered in ERCP, whereas others are unique for MRCP.
    Abdominal Imaging 05/2004; 29(3):360-87. DOI:10.1007/s00261-003-0119-6 · 1.63 Impact Factor
  • Source
    The American journal of roentgenology, radium therapy, and nuclear medicine 11/1972; 116(2):337-41. DOI:10.2214/ajr.116.2.337
  • [Show abstract] [Hide abstract]
    ABSTRACT: Common-bile-duct growths are rarely identified unless they cause chronic biliary obstruction. This case report describes a 71-year-old woman who had jaundice and epigastric pain. A cholecysto-colonic fistula was demonstrated by endoscopic retrograde cholangiopancreatography. The patient also had multiple filling defects in the common bile duct. The fistula was closed and stones were removed. A postoperative cholangiogram showed two calculi. One was removed with a basket through the T-tube tract, but the second, which did not appear completely free of the common-duct wall, could not be removed by the basket method. Subsequently at laparotomy this was found to be a benign pedunculated polyp, composed of collagenous and vascular tissue and with no surface epithelium. Surgeons should bear in mind the possibility of a common-bile-duct growth in cases of extrahepatic biliary obstruction.
    Canadian journal of surgery. Journal canadien de chirurgie 02/1988; 31(1):37-8. · 1.51 Impact Factor
Show more


36 Reads
Available from