Acute cholangitis MRCP

A 64-year-old man presented to the emergency department complaining of severe right upper quadrant abdominal pain, nausea, vomiting, and fevers. Laboratory data revealed an elevated white blood cell count with a left shift, elevated liver function tests including bilirubin, and elevated pancreatic enzymes. A right upper quadrant ultrasound revealed a dilated bile duct with possible stones in the bile duct and gallbladder. Magnetic resonance cholangiopancreatography (MRCP) was performed and revealed multiple filling defects in the common bile duct and cystic duct (arrows).