Intrahepatic cholestasis associated with an enlarged gall-bladder

A 60-year-old man with a history of ingesting herbal medication and a 59-year-old woman with malignant lymphoma presented with painless jaundice and palpably enlarged gall-bladders. Abdominal ultrasonography confirmed that the gall-bladders were enlarged, but showed normal-sized biliary trees with no stones. The final diagnoses for these patients were drug-induced hepatitis with intrahepatic cholestasis and lymphomatous infiltration of the liver, respectively. A palpable gall bladder in cholestatic jaundice may not always be caused by extrahepatic biliary obstruction, and ultrasonography is very useful in ruling this out.