Sound Bite 12 - Gallstones/Dilated CBD (Paeds)

Author: Dr Nick Mani

A 7 yr old girl arrives at the Emergency Department with acute upper abdominal pain and jaundice. She is pyrexial, has RUQ tenderness, and metabolic acidosis on capillary blood gas.

IV antibiotics and fluids was prescribed but challenging vascular access as attempted by one of the junior doctors earlier who had called you to review the patient.

You decide to gain vascular access with ultrasound guidance whilst resisting the events, and then perform POCUS of biliary system as an extension of your standard clinical assessment: -

Clips- Long and short axis of the gallbladder/CBD with colour doppler off/on- demonstrating gallstone and dilated CBD with the ‘double barrel shotgun’ sign

Case Resolution

The laboratory bloods that come back after you have completed all your assessment demonstrated deranged LFTs and signs of infection.

The enhanced clinical assessment by POCUS allowed timely diagnosis, management and urgent referral of cholecystitis/cholangitis due to chole-lithiasis/-docholithiasis. Subsequently, the child was transferred to a tertiary paediatric centre where she underwent surgery and had a good outcome.

Take Home Message

POCUS of the biliary can be rapidly performed to augment the standard clinical assessment (particularly if deciding medical vs surgical cause of deranged LFTs), ultimately improving patient care and safety.