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Figure 4a. Bulging papilla from a distal CBD stone in a 48-year-old man. (a) Unenhanced CT scan shows a high-attenuation stone (arrow) in the intrapancreatic portion of the distal bile duct. (b) On a contrast-enhanced CT scan obtained at the same level, the stone is surrounded by inflammatory change in the ampulla of Vater, which causes bulging of the papilla with increased targetlike enhancement (arrow). (c) Endoscopic image obtained after stone removal shows pus leaking from the severely inflamed papilla.
