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Marked intrahepatic duct dilatation with a stricture present within the common hepatic/bile ducts. There is mural thickening with slight shouldering, which demonstrates increased enhancement on all post intravenous gadolinium phases when compared to the gallbladder/intrahepatic ducts, including progressive enhancement on the 10-minute delayed images.
Biliary tree anatomy is suggestive of a “triple confluence” of the left hepatic duct with the right anterior and right posterior hepatic duct, with no clear separate right hepatic duct. Mural thickening extends along the proximal portion of the intrahepatic ducts, however, there is no clear contrast enhancement in this region and involvement is not definite.
The gallbladder is contracted and is difficult to assess for cholelithiasis/sludge as well as for mural thickening/abnormal enhancement. No filling defect within the dilated intrahepatic ducts.
No enlarged nodes using short axis criteria within the upper abdomen. Non-specific retroperitoneal fluid with further fluid seen around the descending duodenum as well as a small volume within the intraperitoneal of the upper abdomen. There is a small cystic lesion of the neck/body of the pancreas.
There is a stricture of the common/hepatic bile ducts with marked intrahepatic duct dilatation and involvement of the hilum. The enhancement pattern of the stricture is progressive throughout all phases and is suspicious for a cholangiocarcinoma on imaging. The patient proceeded to ERCP and stent placement; brushings were consistent with cholangiocarcinoma on cytology.