Figure 5a. Bulging papilla from an impacted stone in the ampulla of Vater in a 37-year-old woman. (a) Contrast-enhanced coronal reformatted CT image shows bulging of the papilla (arrow) caused by an impacted stone in the ampulla of Vater, along with upstream bile duct dilatation. (b) Endoscopic image also shows marked bulging of the papilla caused by the impacted stone in the ampulla of Vater.