Xiao Zhou is a handsome young man, bank work, married for two years. Originally a very happy life, but this year, but suffered from a disease, 1-2 episodes per month, no obvious cause, sudden pain in the right upper abdomen, distended nature, accompanied by nausea, and occasionally there is a slight yellowing of the eyeballs, the symptoms lasted a few hours to 1-2 days ranging. He went to several hospitals, and ultrasound revealed some dilatation of the intrahepatic bile ducts with some strong spots inside. However, CT examination was performed and no other problems were found except for some dilatation of the intrahepatic bile ducts. Other blood tests were normal except for a mild increase in transhydrogenase. Zhou followed the doctor’s instructions to take a variety of anti-inflammatory choleretic drugs, but the symptoms still flare up from time to time. With anxiety, Xiaozhou came to Hunan Hepatobiliary Hospital. He was warmly received by the professor, who understood his condition in detail and, combined with the examination, initially considered primary cholesterol intrahepatic bile duct stones. Xiao Zhou followed the professor’s advice and was hospitalized and successfully underwent surgery to remove many intrahepatic cholesterol crystals, and Xiao Zhou resumed his happy life. After the surgery, the doctor introduced that primary cholesterol intrahepatic stones are a disease with increasing incidence in recent years, which is significantly different from the traditional intrahepatic bile duct stones, and does not occur more often in rural areas with poor sanitary conditions. There is no history of biliary roundworms or biliary tract infections, and the disease is a biliary metabolic disorder caused by an imbalance in the ratio of bile components, leading to the formation of cholesterol crystals. The stone particles are not as large as bile pigment stones. Therefore, hyperechoic spots of intrahepatic bile ducts can be detected under ultrasound, but there is mostly no positive finding under CT. Surgical treatment of biliary exploration and stone removal, combined with hepatic lobectomy, is the main modality. It is especially important to check more regularly after surgery and to take stone dissolving drugs every year for prevention.