Article Text

Download PDFPDF
A large choledochocystolithiasis mimicking Mirizzi syndrome
  1. Mustafa Belal Hafeez Chaudhry, Main Author1,
  2. Muhammad Azeemuddin1,
  3. Muhammad Rizwan Khan2,
  4. Om Parkash3
  1. 1Department of Radiology, Aga Khan University, Karachi, Pakistan
  2. 2Deparment of Surgery, Aga Khan University, Karachi, Pakistan
  3. 3Department of Medicine, Aga Khan University, Karachi, Pakistan
  1. Correspondence to Dr. Mustafa Belal Hafeez Chaudhry, belal.ibnehafeez{at}


An 18-year-old man presented with spontaneous severe epigastric pain, progressing and radiating to back since 3 days. It was associated with epigastric tenderness, bilious vomiting and jaundice. He had been intermittently experiencing these symptoms for the last 1 year. No known comorbid. Ultrasound showed a poorly visualised heterogeneous focus at porta hepatis; considering poor visualisation, this might represent an enlarged calcified lymph node or cystic duct calculus causing extrinsic compression or a large sludge ball within the common bile duct (CBD), leading to dilatation of common hepatic duct and intrahepatic biliary system. Subsequent magnetic resonance cholangiopancreatography revealed a focal saccular dilatation of middle part of CBD, a type I-B choledochal cyst, large heterogeneous focus seen within it representing choledochocystolithiasis. Later, CT was performed for further characterisation of surrounding anatomy and pathology, which confused the appearance of choledochocystolithiasis for Mirizzi syndrome. Later, surgery and histopathology confirmed type I-B choledochocystolithiasis and chronic cholecystitis.

  • Radiology
  • Pancreas And Biliary Tract
  • Gastrointestinal Surgery
  • General Surgery

Statistics from


  • Contributors MBHC diagnosed the case with MA on MRCP. OP was a treating physician and MRK treated the patient and performed surgery. MBHC selected the images and wrote the manuscript with the help of MA. MRK and OP endorsed the manuscript and images. All the authors contributed to the intellectual context and approved the final version.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.