Abstract
A 71-year-old woman presented to the emergency department with 3 months of intermittent right upper quadrant pain. Laboratory results showed a total bilirubin of 0.6 mg/dL, aspartate aminotransferase of 52 IU/L, alanine aminotransferase of 90 IU/L, and alkaline phosphatase of 239 IU/L. A computed tomography of the abdomen and pelvis was performed, which revealed a large 9 × 4 × 4 cm hyperdense mass underneath the liver, adjacent to the gallbladder (Figure A, arrowhead). An endoscopic ultrasound showed a very large radiopaque filing defect in a very dilated bile duct, and a cholangiogram during endoscopic retrograde cholangiopancreatography confirmed a very large stone occupying the entire common bile duct (Figure B, arrowheads trace stone outline).
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