PMC5971341_01
Coronal MRI image demonstrating large gallbladder empyema (a), and transverse MRI image section demonstrating 12 mm obstructing gallstone in the cystic duct (b).
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fig1
Her white cell count was elevated, and a magnetic resonance cholangiopancreatography (MRCP) revealed an empyema of the gallbladder (Figure 1). There was an obstructing calculus in the cystic duct (Figure 1); however, the biliary tree was nondilated.
Fluoroscopy-guided insertion of a collapsed 6 mm x 60 mm bare metal stent into the cystic duct prior to deployment (a). Note the round filling defects, consistent with gallbladder calculi (arrows). Subsequent successful deployment of a 6 mm x 60 mm bare metal stent in the cystic duct, and an 8 mm x 100 mm bare metal stent in the common bile duct and duodenum, with antegrade contrast clearance (b).
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fig2
A 6 mm x 60 mm bare metal stent was inserted into the cystic duct (Figure 2), and an 8 mm x 100 mm bare metal stent was inserted from the mid-cystic duct through the ampulla of Vater into the duodenum. Rapid antegrade clearance of contrast from the gallbladder was then demonstrated on cholecystogram (Figure 2).
CT scan two days after stent insertion demonstrating appropriate positioning and relative size of the bare metal stents in the cystic and common bile ducts.
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fig3
A CT scan confirmed appropriate positioning and sizing of the metallic stents (Figure 3) and revealed a collapsed gallbladder with no discrete collection.