Jaundice, pruritus, abdominal pain and deranged LFTs.
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A tiny nodule was seen in the right middle lobe.
Normal fat planes preserved around major abdominal aortic branches.
No sizable lymphadenopathy.
The liver is average size and density with no definite suspicious focal lesions.
The pancreatic head, neck, body and tail showing normal enhancement with no definite suspicious lesions seen
Unremarkable CT features of the portal vein, spleen, adrenals, kidneys, urinary bladder, and visualized bowel loops.
No ascites were seen.
The visualized osseous structures showing small bony defect seen in the right iliac bone with an adjacent small bony projection which appearing of benign nature could be due to the previous operation for clinical history correlation with no definite suspicious bony lesions.
- The patients typically present with symptoms related to biliary obstruction of, Painless jaundice, pruritus, abdominal pain and an increased liver enzyme.
- Patient subjected to US abdomen and revealed dilated CBD and intrahepatic biliary radicles.
- Then requested for CT abdomen and pelvis shows; the above-mentioned findings of an ampullary lesion and double duct sign in not displayed here, A normal-sized pancreatic duct does not exclude the diagnosis of ampullary neoplasm because the ductal calibre will be normal in up to 50% in patients with bile duct obstruction caused by an ampullary tumour.
- Then endoscopic biopsy of this lesion showed adenocarcinoma of the ampulla of Vater.
- Then lastly subjected to Whipple's operation and the patient is good and underwent follow up.
Ampullary carcinoma is a rare malignant tumor originating at the ampulla of Vater, in the last centimeter of the common bile duct, where it passes through the wall of the duodenum and ampullary papilla.
- 1-Raman SP, Fishman EK. Abnormalities of the distal common bile duct and ampulla: diagnostic approach and differential diagnosis using multiplanar reformations and 3D imaging. AJR. American journal of roentgenology. 203 (1): 17-28. doi:10.2214/AJR.13.11288 - Pubmed
- 2-Nikolaidis P, Hammond NA, Day K, Yaghmai V, Wood CG, Mosbach DS, Harmath CB, Taffel MT, Horowitz JM, Berggruen SM, Miller FH. Imaging features of benign and malignant ampullary and periampullary lesions. Radiographics : a review publication of the Radiological Society of North America, Inc. 34 (3): 624-41. doi:10.1148/rg.343125191 - Pubmed
- 3-Ahualli J. The double duct sign. Radiology. 244 (1): 314-5. doi:10.1148/radiol.2441041978 - Pubmed