PMC8571195_01
A 30-year-old woman with symptoms of the right upper quadrant pain and fever. The diagnosis was cholangitis due to recurrent biliary stones and postsurgical choledochal cyst. Coronal T2-weighted images show a large biliary stone (arrow) (a) and some small biliary stones (arrow) (b). Axial T2-weighted images show a large biliary stone (arrow) (c) and some small biliary stones (arrow) (d) which frame huge dilations of the intrahepatic biliary ducts.
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F1
Type IVa choledochal cyst, with many framing stones filling the biliary branches [Figure 1].
A 30-year-old woman with symptoms of the right upper quadrant pain and fever. The diagnosis was cholangitis due to recurrent biliary stones and postsurgical choledochal cyst. Single-shot digital subtraction angiography before lithotripsy reveals a giant hepatolithiasis. The patient underwent hepaticojejunostomy during a prior choledochal cyst surgery.
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F2
Imaging revealed very large stones [Figure 2]. 3 days later, a lithotripsy procedure was performed.
A 30-year-old woman with symptoms of the right upper quadrant pain and fever. The diagnosis was cholangitis due to recurrent biliary stones and postsurgical choledochal cyst. Image of cholangioscopy before (a) and after (b) lithotripsy (arrow in a: Biliary stone).
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F3
The holmium laser tip (Accu Tech, USA) was guided to the stone position to conduct the lithotripsy [Figure 3].
A 30-year-old woman with symptoms of the right upper quadrant pain and fever. The diagnosis was cholangitis due to recurrent biliary stones and postsurgical choledochal cyst. Single-shot digital subtraction angiography after lithotripsy confirmed the disappearance of the hepatolithiasis.
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F4
The procedure was successful, and cholangiography verified the absence of residual stones [Figure 4].