Abstract
Background
Measurement of the common bile duct (CBD) has traditionally been considered an integral
part of gallbladder sonography, but accurate identification of the CBD can be difficult
for novice sonographers.
Objective
To determine the prevalence of isolated sonographic CBD dilation in emergency department
(ED) patients with cholecystitis or choledocholithiasis without laboratory abnormalities
or other pathologic findings on biliary ultrasound.
Methods
We conducted a retrospective chart review on two separate ED patient cohorts between
June 2000 and June 2010. The first cohort comprised all ED patients undergoing a biliary
ultrasound and subsequent cholecystectomy for presumed cholecystitis. The second cohort
consisted of all ED patients receiving a biliary ultrasound who were ultimately diagnosed
with choledocholithiasis. Ultrasound data and contemporaneous laboratory values were
collected. Postoperative gallbladder pathology reports and endoscopic retrograde cholangiopancreatography
(ERCP) reports were used as the criterion standard for final diagnosis.
Results
Of 666 cases of cholecystitis, there were 251 (37.7%) with a dilated CBD > 6 mm and only
2 cases (0.3%; 95% confidence interval [CI] 0.0–0.7%) of isolated CBD dilation with
an otherwise negative ultrasound and normal laboratory values. Of 111 cases of choledocholithiasis,
there were 80 (72.0%) with a dilated CBD and only 1 case (0.9%; 95% CI 0.0–2.7%) with
an otherwise negative ultrasound and normal laboratory values.
Conclusion
The prevalence of isolated sonographic CBD dilation in cholecystitis and choledocholithiasis
is <1%. Omission of CBD measurement is unlikely to result in missed cholecystitis
or choledocholithiasis in the setting of a routine ED evaluation with an otherwise
normal ultrasound and normal laboratory values.
Keywords
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Article info
Publication history
Published online: October 14, 2013
Accepted:
March 15,
2013
Received in revised form:
March 7,
2013
Received:
August 29,
2012
Footnotes
The views expressed in this article are those of the authors and do not reflect the official policy or position of the Department of the US Army, Department of Defense, or the US Government.
Reprints are not available from the authors.
Identification
Copyright
© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
