Presentation
Presented with painless jaundice & hyperbilirubinemia
Patient Data
Lesion noted in segment 4. ?significance
Intrahepatic duct dilatation & dilatation of right (8 mm) & left hepatic (10 mm) ducts. Stenosis noted to at the junction of the hepatic ducts. Distal CBD (6 mm) appears normal while the stenosed ducts have a beaked appearance. There is no underlying pancreatic mass and a normal branching pattern of the common hepatic artery. Noted is sludge within a distended gallbladder (4.4 cm) with multiple stones. No findings to indicate acute cholecystitis. Segment III lesion demonstrates rim enhancement. No other lesion in the liver. The spleen, adrenal glands & kidneys are normal
Case Discussion
The operation report included the following findings: Cholangiocarcinoma from extrahepatic bile duct adhered to right hepatic artery, portal vein and gallbladder. Metastatic disease on liver (one single 2 cm metastasis in segment III), lymphovascular invasion.
Pathology findings correlated with op report.
This case highlighted the difficulty in characterizing liver lesions. This patient underwent a lengthy surgical procedure for what was determined to be metastatic disease.
Hepatic metastases tend to show mild to moderate high intensity signal on T2W imagine & low signal on pre-contrast T1. Cystic & necrotic metastases show T2 increase signal (commonly in neuroendocrine tumors and sarcoma). Some liver metastases may demonstrate T1 hyperintensity particularly if fat-containing or melanin/methemoglobin/protein containing (such as melanoma).
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