Abdominal pain, vomiting and jaundice
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Diffuse infiltrative lesion is noted involving subsegment IVa and VIII of the liver, it is ill defined, hypodense with evidence of peripheral enhancement in portovenous phase and becomes smaller in the delayed phase. It is associated with localized intra hepatic biliary radical dilatation at the left hepatic lobe and with mulitple variable size scattered focal lesion at both hepatic lobes showing marginal enhancement. Nevertheless, there is traction on the hepatic capsule at the anterior segment of right lobe and thrombus wtihin the SMV and partially occluding the main PV. Bone window images show two small osteolytic lesions at L3 vertebral body and another one at the right ileum. Lung bases show few subcentimetric pulmonary nodules at the left lower lobe. Simple right renal cyst and minimal ascites are noted.
Lab investigation revealed elevated CA 19-9 which measures 800 U/ml (Strikingly high). CT revealed intra hepatic cholangiocarcinoma with liver deposits, lung deposits and bony deposits. US guided biopsy confirmed the diagnosis and the lesion was unresectable hence the patient was referred to oncology department.