Presentation
Obstructive jaundice and weight loss
Patient Data
Intrahepatic dilatation is noted. The common bile duct measures up to 14 mm diameter and abruptly narrows at the superior margin of the head of the pancreas. The pancreatic head appears bulky with ill-defined enhancement on both arterial and portal venous phase but no discrete mass is identified. Inferiorly adjacent a duodenal diverticulum is noted. The remainder of the pancreas is atrophic. Peripancreatic fat planes appear preserved with no fat stranding. The splenic and main portal veins are patent with no evidence of thrombus. No retroperitoneal or abdominal lymphadenopathy.
No focal liver lesion is identified. Previous cholecystectomy is noted. The spleen, left kidney and adrenals are normal in appearance. Small cortical cysts noted in the right kidney. The imaged bowel is unremarkable. No peritoneal free fluid or gas.
No suspicious osseous lesions.
Conclusion
Intrahepatic and extrahepatic biliary dilatation with abrupt narrowing of the distal common bile duct at the head of the pancreas but no discrete pancreatic mass identified. This likely represents malignant stricture of the distal common bile duct from either an ductal cholangiocarcinoma or a pancreatic head mass.
Case Discussion
ERCP washings and EUS biopsy confirmed cholangiocarcinoma.
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