Biliary - Twinkling Artifact in Choledocholithiasis
Caption
A patient presented with RUQ abdominal pain. Ultrasound showed cholelithiasis and choledocholithiasis. Left image shows a portion of the common bile duct containing a small hyperechoic shadowing mobile stone. Right image shows the same with color Doppler added demonstrating twinkling artifact. Learning point: Twinkling artifact is most often associated with urinary stones but also can be caused by gallstones (depending on composition), bowel gas, foley balloons, metallic objects, and many others. Twinkling artifact may help identify small stones that do not cause prominent acoustic shadowing. Michael Cover, MD @michaelc0ver