This 87 y/o female, with a history of lymphoma, presented with painless jaundice, and serum chemistry studies consistent with biliary obstruction. Selected images from her abdominal CT demonstrate a dilated biliary tree with filling defects in the common bile duct consistent with stones. Incidental note was made of a prominent spleen. Primary lymphomatous involvement of the biliary tree seemed unlikely as this usually has an appearance akin to sclerosing cholangitis. Extra hepatic biliary obstruction secondary to nodal or pancreatic lymphoma or myeloma would not be expected to demonstrate filling defects in the CBD. Because of our seeming certainty in the diagnosis of CBD stone(s), both spiral CT cholangiography and/or MR cholangiography as well as ERCP and/or PTC were bypassed. Cholecystectomy and common duct exploration with stone removal led to resolution of the jaundice and return of the serum chemistry studies to normal.
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