Case 10

This week's case was an example of intrahepatic biliary ductal dilation on ultrasound.  We see it so often in other modalities, but it's not as commonly seen on ultrasound, where we are supremely reliant on our technologists. If they don't see it and take an image of it, we usually won't see it.  Thankfully, in our protocols, our technologists are supposed to take cine sweeps through any pathology and certain structures, where we might catch things they miss.  Always look at the sweeps to look for missed pathology.

Two anechoic tubular structures, which is abnormal due to the intrahepatic bile duct dilation.

Remember this from histology? The portal triad

Remember: if you see two hypodense structures surrounding the portal vein, it's periportal edema, and it will extend along all branches of the portal vein. If you look at the left portal vein branch in this image, there is only 1 hypodense structure along the posterior aspect of the portal vein, meaning this is bile duct dilation. 

The CBD is also dilated. In this patient, this was all an expected sequela of prior cholecystectomy.