Presentation
Right upper quadrant pain associated with nausea, vomiting, and chills.
Patient Data
There is echogenic/tumefactive sludge within the gallbladder with borderline gallbladder wall thickening. No shadowing gallstones are visible.
There is intrahepatic biliary ductal dilatation. The common bile duct is also dilated and is filled with echogenic, avascular/sludge material. There is no posterior acoustic shadowing or enhancement.
Case Discussion
This is a case of tumefactive sludge. Given the above ultrasound, a differential of tumefactive sludge, mass, and large common bile duct (CBD) stone was raised. A mass was felt less likely due to the absence of color Doppler flow. Additionally, a large CBD stone was felt to be less likely given the absence of acoustic shadowing (which would be seen given the sheer size of the stone).
She underwent an endoscopic ultrasound which showed numerous round stones and sludge material in the common bile duct. No large dominant stone within the common bile duct was seen. A follow-up endoscopic retrograde cholangiopancreatography removed small, round stones and thick, sludge-like material. The patient received a sphincterotomy and a plastic stent was placed.
Co-author:
Yostina Soliman
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