Don’t become Jaundiced about POCUS

This patient came in with jaundice and the LFTs were elevated. They had had a cholecystectomy in the past. POCUS revealed a large dilated fluid-filled structure in the RUQ. After looking at the kidneys/liver +/- Doppler it became clear it was a very dilated CBD. CT confirmed the biliary dilatation and obstructing mass. [Ed. note: Great call by Lloyd. The CBD is a bit tougher to identify without a gallbladder present. For one thing, you lose the exclamation in the exclamation point sign. For another, the CBD is often dilated post-choly and can look like the portal vein. Color Doppler is key. No flow = CBD. This CBD is massive!]