Point-of-Care Ultrasound Assists Diagnosis of Spontaneously Passed Common Bile Duct Stone |
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| Authors: | Meghan Kelly Herbst Cindy Li Sara Blomstrom |
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| Affiliation: | 1. Le Bonheur Children''s Hospital, Memphis, Tennessee;2. Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, Tennessee;3. University of Tennessee Health Science Center, College of Medicine, Memphis, Tennessee;4. Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee;1. Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland;2. University of Maryland School of Medicine, Baltimore, Maryland;1. Oakland University William Beaumont School of Medicine, Rochester, Michigan;2. Department of Emergency Medicine, St. John Hospital and Medical Center, Detroit, Michigan;3. Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, Michigan;1. Department of Family Medicine, Taipei Municipal WanFang Hospital, Taipei City, Taiwan;2. Department of Emergency Medicine, New Taipei City Municipal Tucheng Hospital, Taipei City, Taiwan;3. Department of Emergency Medicine, Chang Gung Memorial Hospital, Taoyuan City, Taiwan;1. Department of Emergency Medicine, SUNY Downstate Health Sciences University, Brooklyn, New York;2. Department of Emergency Medicine, Kings County Hospital Center, Brooklyn, New York |
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| Abstract: | BackgroundCholedocholithiasis complicates approximately 10% of gallstone disease. Spontaneous stone migration out of the common bile duct (CBD) may occur in as many as 20% of choledocholithiasis cases. A decrease in CBD caliber occurs in the setting of spontaneous stone passage, but to our knowledge, this finding has not been appreciated using point-of-care ultrasound (POCUS) in the emergency medicine setting.Case ReportA 49-year-old woman presented to our Emergency Department (ED) with a complaint of epigastric pain radiating to the left shoulder. On examination she was found to have epigastric tenderness to palpation, but no guarding or rebound. POCUS demonstrated a dilated common bile duct, and her liver function tests were abnormally high. She was admitted to Medicine with concern for choledocholithiasis and plan for endoscopic retrograde cholangiopancreatography (ERCP), but her pain had resolved shortly after ED arrival. A repeat ultrasound examination demonstrated a normal-caliber common bile duct approximately 3 h after the initial scan.Why Should an Emergency Physician Be Aware of This?Choledocholithiasis often requires admission and invasive testing. Using POCUS in conjunction with liver function tests and patient assessments may obviate a need for ERCP. |
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| Keywords: | choledocholithiasis common bile duct dilatation spontaneous bile duct stone migration ultrasound point-of-care ultrasound bedside ultrasound |
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