Segment IV cholangiocarcinoma

Case contributed by Jack Ren

Presentation

Recent abdominal pain

Patient Data

Age: 70-75
Gender: Male
Modality: MRI

There is a 4.2 x 3.6 x 3.9 cm mass centred in segment IV. It is causing intrahepatic duct dilation of segment II, III, IV, with advanced atrophy of segment IV.

No other lesion is noticed.No extrahepatic dilation (CBD = 4mm).

This tumour abuts the right hepatic vein for a significant length, and is close to but not involving the right bile ducts.

The left umbilcal portal vein, and the left hepatic is directly involved by tumour.

The transverse portion of the left portal vein is not involved.

The right hepatic artery is replaced.

The liver demonstrates a drop in signal on the out of phase T1 sequence in keeping with mild fatty infiltration.

There are several lobulated cystic lesions within the pancreas. The two prominent are at the head (2cm) and body/tail (1.1cm). They appear to communicate with the main pancreatic duct. No pancreatic duct dilation. No post contrast enhancement. 

The adrenals, spleen and visualised kidneys are unremarkable.

There is 1.4 cm lymph node at the portal region. No other lymphadenopathy.

Conclusion

A 4.2 cm segment IV cholangiocarcinoma with early obstruction of the left lateral sector.

A considerable length of the middle hepatic vein borders the tumour.Metastatic portal lymphadenopathy.

A few small pancreatic IPMN, in the head and in the tail.

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Case Information

rID: 30390
Case created: 7th Aug 2014
Last edited: 4th Oct 2015
Inclusion in quiz mode: Included

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