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Liver fluke-related biliary disease is rare in the United States, as locally-acquired liver fluke infection is uncommon. Presented here is a case of biliary obstruction secondary to fluke infection in a Burmese immigrant to the United States. Imaging findings are presented using computed tomography, ultrasound, magnetic resonance imaging, and fluoroscopy which revealed severe biliary dilatation resulting from large obstructing stones. The offending parasite was identified via stone analysis following surgical extraction. Keywords: Choledocholithiasis, Liver Fluke