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Does incidentally detected common bile duct dilation need evaluation?

Anam Rizvi, MD, Amrita Sethi, MD, John Poneros, MD and Kavel H. Visrodia, MD
Cleveland Clinic Journal of Medicine June 2022, 89 (6) 315-319; DOI: https://doi.org/10.3949/ccjm.89a.21029

Article Figures & Data

Figures

  • FIGURE 1
    FIGURE 1

    Clinical approach to incidental bile duct dilation.

    CT = computed tomography; ERCP = endoscopic retrograde cholangiopancreatography; EUS = endoscopic ultrasonography; MRCP = magnetic resonance cholangeopancreatography

    Based on information in reference 1.

Tables

  • TABLE 1

    Clinical considerations and red flags for incidental bile duct dilation

    Clinical signs of bile obstruction
    Jaundice
    Steatorrhea
    Acholic stools
    Dark urine
    Pruritus
    Weight loss (concern for malignancy)
    Fever, right upper quadrant abdominal pain, and jaundice (concern for ascending cholangitis)
    Relevant findings on laboratory testing
    Elevation of any of the following:

    • Total or direct serum bilirubin

    • Alkaline phosphatase

    • Aspartate aminotransferase

    • Alanine aminotransferase

    Abnormal imaging findings
    Concurrently dilated pancreatic duct (“double-duct” sign)
    Intraductal stone or lesion
    Intrahepatic duct dilation
    Moderate to severe extrahepatic duct dilation (≥ 10 mm)
    Abrupt cutoff in common bile duct dilation
    New or progressive dilation compared with prior imaging
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