Biliary pseudolithiasis

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Biliary pseudolithiasis is a medical condition characterized by the presence of sludge or sludge-like material in the biliary tract that mimics the appearance of gallstones on imaging studies. Unlike true gallstones, biliary pseudolithiasis does not consist of solid calculi but rather of thickened bile or biliary sludge.

Etiology

Biliary pseudolithiasis is often associated with the use of certain medications, particularly ceftriaxone, a third-generation cephalosporin antibiotic. The condition can also be seen in patients with biliary stasis, total parenteral nutrition, or other conditions that alter the composition of bile.

Pathophysiology

The pathophysiology of biliary pseudolithiasis involves the precipitation of bile components, such as cholesterol crystals, bilirubin particles, and mucin, forming a sludge-like material. This material can accumulate in the gallbladder or the common bile duct, leading to symptoms similar to those caused by true gallstones.

Clinical Presentation

Patients with biliary pseudolithiasis may present with symptoms similar to those of cholelithiasis, including:

• Right upper quadrant pain
• Nausea
• Vomiting
• Jaundice

Diagnosis

The diagnosis of biliary pseudolithiasis is typically made using imaging studies such as ultrasonography or magnetic resonance cholangiopancreatography (MRCP). These imaging modalities can reveal the presence of sludge or sludge-like material in the biliary tract.

Management

Management of biliary pseudolithiasis primarily involves addressing the underlying cause. If the condition is associated with medication use, discontinuation of the offending drug, such as ceftriaxone, may lead to resolution of the pseudolithiasis. In some cases, supportive care and symptomatic treatment may be necessary.

Prognosis

The prognosis for patients with biliary pseudolithiasis is generally good, especially if the underlying cause is identified and managed appropriately. The condition is often reversible once the precipitating factor is removed.

See Also

• Cholelithiasis
• Cholecystitis
• Biliary tract
• Gallbladder