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Pseudocalculus sign. A pitfall of static cholangiography.
The American Surgeon
|April 1, 1986
Summary
The pseudocalculus sign is a cholangiographic illusion mimicking bile duct stones. Correctly identifying this sign is crucial to prevent unnecessary procedures and reoperations.
Area of Science:
- Radiology
- Gastroenterology
- Biliary Imaging
Background:
- The pseudocalculus sign, first described in 1960, is a cholangiographic finding.
- It presents as a filling defect in the distal common bile duct.
- This sign is often observed during T-tube cholangiography, but also during intravenous and intraoperative cholangiography.
Purpose of the Study:
- To review the anatomy and physiology of the distal common bile duct.
- To discuss the etiology, differential diagnosis, and recognition of the pseudocalculus sign.
Main Methods:
- Review of existing literature on the pseudocalculus sign.
- Analysis of cholangiographic findings and their interpretation.
Main Results:
- The pseudocalculus sign is an illusion caused by the contractile phase of the choledochal sphincter.
- It mimics a radiographically impacted stone in the distal common bile duct.
- Accurate identification is critical to avoid misdiagnosis.
Conclusions:
- Understanding the pseudocalculus sign is essential for accurate biliary imaging interpretation.
- Delineation of this sign prevents unnecessary common bile duct instrumentation and reoperation.