This patient presented with acute cholecystitis, as confirmed at imaging. His pain resolved over a few days, but mildly elevated bilirubin levels persisted. Image obtained during ERCP shows smooth narrowing of the bile duct (arrow) at the site of insertion of the cystic duct (Mirizzi syndrome). Note the small calculus in the cystic duct. Courtesy of Dr. Ali Nawaz Khan.
Classification:
Type I - No fistula present
Type IA - Presence of the cystic duct
Type IB - Obliteration of the cystic duct
Types II-IV - Fistula present
Type II - Defect smaller than 33% of the CBD diameter
Type III - Defect 33-66% of the CBD diameter
Type IV - Defect larger than 66% of the CBD diameter
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