Role of computerized tomography in diagnosis of atypical gall bladder and common bile duct stones

OBJECTIVE: To assess the value of computerized tomography as an adjuvant to ultrasound in the diagnosis of atypical gallbladder and common duct stone disease.

METHODS: Real time ultrasound scanning for the gallbladder and common duct was performed in the routine manner. High resolution computerized tomography images were subsequently obtained for the region of interest.

RESULTS: Computerized tomography resolved undetermined results as follows: 1. Non shadowing gallbladder debris (6 points), 2. Focal gallbladder wall thickening (2 points), 3. Stone obscured by calcified gallbladder wall (3 points), 4. Non visualized gallbladder double arc shadow (4 points), 5 and 6. Impacted gallbladder neck and common duct stones (18 points), computerized tomography gave false positive diagnosis in (2 points).

CONCLUSION: Computerized tomography provided an effective and reliable means for the diagnosis of atypical gallbladder calculi when ultrasound was imprecise or the findings contradicted the clinical presentation. Finally if gallbladder neck or common duct stones are suspected, in addition to computerized tomography other imaging techniques such as magnetic resonance cholangio pancreatography or endoscopic retrograde cholangiopancreatography in addition to computerized tomography may be needed to avoid false positive diagnosis prior to surgery.