84 Magnetic Resonance Cholangiography

CLINICAL IMAGAGINGAN ATLAS OF DIFFERENTIAL DAIGNOSIS

EISENBERG

DR. Muhammad Bin Zulfiqar PGR-FCPS III SIMS/SHL

Fig GI 84-1 Biliary and gallbladder stones. Multiple calculi in both the dilated extrahepatic bile duct (arrows) and gallbladder (arrowheads).176

• Fig GI 84-2 Impacted ampullary stone. Large obstructing calculus (white arrow) results in proximal bile duct dilatation. There are also several gallstones (black arrows).176

• Fig GI 84-3 Gallstone. Large gallbladder calculus (black arrow) in a young man with sickle cell disease. Note the normal-caliber bile duct (white arrowhead).176

• Fig GI 84-4 Multiple gallstones. Innumerable small calculi fill the gallbladder (straight arrows). The cystic duct (arrowhead) does not contain any calculi.176

• Fig GI 84-5 Mirizzi syndrome. Two calculi in the dilated cystic duct (arrowheads), which parallels the extrahepatic bile duct. The inferior calculus (arrow) eroded through the wall of the cystic duct into the extrahepatic bile duct, bridging the two structures and resulting in obstruction of the bile duct.176

• Fig GI 84-6 Pancreatic metastasis from mucinous colon carcinoma. Obstruction of the intrapancreatic segment of the bile duct (arrow). Note the dilated gallbladder (G). The enlarged lymph nodes with high signal intensity (arrowheads) represent metastases.176

• Fig GI 84-7 AIDS cholangiopathy. Multiple ductal stenoses and irregularities of the right hepatic ducts (arrows) and beading of the left hepatic ducts (arrowheads).176

• Fig GI 84-8 Liver flukes. Diffuse dilatation of the entire intrahepatic biliary ductal system. Note the filling defects (arrows) with the bile ducts due to adult flukes of Clonorchis sinensis.177

• Fig GI 84-9 Stricture resulting from choledochojejunostomy after Whipple procedure for pancreatic carcinoma. Stricture of the common hepatic duct (arrow) extending to the anastomosis between the duct and the jejunum (J). The intrahepatic bile ducts are dilated (arrowheads).176

• Fig GI 84-10 Bile duct obstruction secondary to transection during laparoscopic cholecystectomy. Stricture (arrow) of the left hepatic duct with proximal dilatation (arrowhead).176

• Fig GI 84-11 Aberrant right hepatic duct. The anomalous vessel (arrow) drains into the cystic duct remnant (arrowheads).176

• Fig GI 84-12 Choledochal cyst. Coronal image shows multiple dilated bile ducts with calculi. Multiple stones are seen within the dilated common bile duct (arrow). The cystic dilatations communicate with the major biliary tree.178

• Fig GI 84-13 Gallbladder carcinoma with nodal metastases. Large mass (M) within the gallbladder (arrows) associated with a necrotic nodal metastasis (*), which resulted in proximal bile duct obstruction.176

• Fig GI 84-14 Adenomyomatosis. (A) Small, fluid-filled outpouchings (arrows) arise from the gallbladder, representing Rokitansky-Aschoff sinuses. (B) In the fundus of the gallbladder, there are additional fluid-filled sinuses (arrows), seen en face.176