Differential Diagnosis for 83-year-old Female with Biliary Ductal Dilation and Common Bile Duct Stones
- Single most likely diagnosis:
- Choledocholithiasis with biliary obstruction: This is the most likely diagnosis given the presence of stones within the common bile duct and the dilation of both intrahepatic and extrahepatic biliary ducts. The patient's age and the presence of cholelithiasis in the gallbladder also support this diagnosis.
- Other Likely diagnoses:
- Cholecystitis: Although the gallbladder is described as partially decompressed and suboptimally visualized, the presence of cholelithiasis and the clinical context could suggest chronic or acute cholecystitis.
- Biliary dyskinesia: This condition, characterized by abnormal contraction and relaxation of the biliary ducts, could potentially cause dilation of the biliary ducts, though it is less likely given the presence of stones.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Cholangiocarcinoma: Although less likely, this malignancy of the bile duct could cause obstruction and dilation of the biliary ducts. It is crucial to consider and rule out given the potential for severe outcomes if missed.
- Pancreatic cancer: Despite the pancreas being reported as normal, the possibility of a small, early lesion or a tumor not visualized due to technical limitations should be considered, especially given the patient's age and the presence of biliary obstruction.
- Rare diagnoses:
- Primary sclerosing cholangitis (PSC): A chronic liver disease characterized by inflammation and scarring of the bile ducts, which could lead to their dilation. It is less common and typically associated with inflammatory bowel disease.
- Caroli's disease: A rare congenital disorder of the intrahepatic bile ducts, characterized by dilatation of the intrahepatic biliary ducts. It could be considered if the dilation is primarily intrahepatic and other causes are ruled out.