20-year-old female history of biliary colic status post cholecystectomy. Evaluate for congenital abnormality. ABDOMEN:LIVER, BILIARY TRACT: Mild intrahepatic biliary ductal dilation. There is abnormal thickening and enhancement of the right hepatic duct near Klatskin's point. The common hepatic and proximal common bile ducts are abnormally thickened and irregular. Approximately 3 to 4 cm from the ampulla, there is a short segment duct draining into the common bile duct. The distal aspect of this duct is not seen. In this area, there is a smooth narrowing of the common bile duct. The common bile duct distal to this point takes a long (4cm) intrapancreatic course. Maximum CBD diameter proximal to this anomalous insertion measures 5mm. There are additional faint ducts draining into the common bile ducts, however the distal aspect of these ducts are again, not visualized.The right posterior intrahepatic duct inserts separately into the common hepatic duct, a normal variant.Status post cholecystectomy.No enhancing masses.SPLEEN: Markedly attenuated splenic vein near the pancreatic head/body confluence.PANCREAS: The pancreatic duct is not well visualized. No evidence of active inflammation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
Limited study due to lack of Secretin stimulation.1. Abnormal pancreatic ductal insertion into the common bile duct approximately 3-4 cm from the ampulla likely represents an anomalous insertion of pancreatic ducts, however, the distal aspect of these ducts are not seen. Abnormally long intrapancreatic course of common bile duct measuring 4 cm. Irregular proximal common bile duct as well as abnormal thickening and enhancement of the right intrahepatic bile duct. The constellation of findings can suggests abnormal pancreaticobiliary junction with the sequela of chronic reflux. Another diagnostic consideration is PSC.2. No evidence of pancreatitis, however the splenic vein is markedly attenuated and may be thrombosed.