Common Bile Duct: How useful is it for us to image?

This patient initially gave a history of two months of upper abdominal pain. I was looking at his GB, which seemed normal when I came upon this tubular structure with no flow on Doppler. It certainly looked to be a (very dilated) CBD. Once I saw it, it was natural to ask about weight loss, malaise, and to notice the conjunctival icterus.

This is something I’ve noticed about POCUS. A sort of random finding on U/S focuses my attention on a likely diagnosis and makes me ask the right questions and see the other findings on physical. We just don’t have time to ask every question and look for every finding on physical exam. So the POCUS, rather than adding to our burden, can actually quicken the diagnostic process. It’s sort of like where you’re about to enter into a long investigation for chest pain and you notice the obvious shingles.

The CT showed the big CBD tapering into a bulky head of the pancreas.