Endoscopic Ultrasound in Biliary Colic

Biliary sludge is seen on ultrasound as an amorphous echogenic material, which slowly moves to the dependent part. Endoscopic ultrasound has a sensitivity of 96% to detect biliary sludge, and the appearance is similar to that seen on transabdominal ultrasound. Other entities which can have a similar appearance include blood, pus, necrotic debris, and multiple small stones. This case represents a unique finding on endoscopic ultrasound of an echogenic image in CBD, mimicking biliary sludge.