PMC9238204_01
A 49-year-old male with biliary cast syndrome after endoscopic and percutaneous management of CBD stones.. A. Abdominal CT and endoscopic retrograde cholangiopancreatography show dilatation of the bile duct with CBD stones (arrows).. B. Pre-contrast (left) and portal phase (right) CT images show portal vein thrombosis and periportal edema in the liver.. C. Follow-up cholangiography shows ductal irregularity of the CBD with long intraluminal filling defect (arrow).. D. Cholangiography through percutaneous transhepatic biliary drainage show large elongated filing defect (arrows) of both intrahepatic and CBDs.. E. Fragments of the biliary cast after removal are shown.. F. Contrast-enhanced abdominal CT shows a pseudoaneurysm (arrow) in the distended gallbladder and progression of dilation of intrahepatic ducts with hemobilia.. CBD = common bile duct
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F1
Endoscopic biliary sphincterotomy was performed followed by stone removal (Fig. 1A). Follow-up CT scan showed persist dilated CBD, dilated both intrahepatic bile ducts, and thrombus in the left portal vein (Fig. 1B). Follow-up cholangiography revealed a long intraluminal filling defect (Fig. 1C). The patient was diagnosed with biliary cast syndrome and the cast was extracted using a basket through the PTBD catheter (Fig. 1D). The cast was composed of inflammatory exudates with pigmented material (Fig. 1E). He was diagnosed with cholecystitis and cystic artery pseudoaneurysm (Fig. 1F).