Cholangiocarcinoma

Case contributed by Dr Mohammad Taghi Niknejad

Presentation

Abdominal pain and elevated liver enzymes.

Patient Data

Age: 65 years
Gender: Male
mri

Mild to moderate dilatation is seen at intrahepatic bile ducts. There is no normal connection between right and left intrahepatic bile ducts. Common hepatic and common bile ducts are not dilated. Additionally parenchymal atrophic changes are noted at 4th hepatic segment.
Gallbladder is contracted.

ct

Parenchymal atrophic changes and capsular retraction are seen at anterolateral aspect of liver particularly segments IV, V and VIII. The gallbladder is contracted. 
Intrahepatic bile ducts are dilated without dilatation of extrahepatic bile ducts. An ill defined mass like lesion is observed at connection site of right and left intrahepatic bile ducts.
A few non-enhanced simple cortical cysts are seen at both kidneys.
The prostate gland is enlarged.
Degenerative changes as osteophytosis are seen at the thoracolumbar spine.

Case Discussion

Intrahepatic bile duct dilatation, due to pathology proven cholangiocarcinoma which is the second most common primary hepatobiliary malignancy after hepatocellular carcinoma (HCC). They tend to have a poor prognosis and high morbidity. 

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