79 yo female with hx of known gall stones presented with worsening abdominal pain with nausea and anorexia. Bedside ultrasound of the RUQ showed the following. What is the diagnosis?

This scan shows a gallstone within a dilated common bile duct, aka choledocholithiasis. In th, this video, the stone itself is visualized within the duct with upstream dilatation. Note the posterior shadowing.
When looking to identify the CBD, the use of color flow can be useful to differentiate a dilated CBD from vascular structures.
This patient's labs showed elevated bilirubin, alk phos and transaminases. She underwent MRI, following by ERCP with removal of multiple bile duct stones.
Special thanks to Drs Jenna Otter and Kathleen Fane for their ultrasound skills!

- Jessica Patterson, MD, Emergency Medicine Ultrasound Fellow