Abdominal Pain, Nausea

The patient had this pain for several weeks and could find no relief.

Figure 1. Longitudinal image of the lateral lobe of the liver demonstrates intrahepatic ducal dilatation.

Figure 2. Longitudinal image of the right liver demonstrates more ductal dilatation throughout the liver.

Figure 3. Transverse image of the left lobe of the liver demonstrates intrahepatic ductal dilatation as well.

Figure 4. Longitudinal image of the left lobe of the liver with the color box on demonstrating the intrahepatic ductal dilatation.

Figure 5. Proximal portion of the CBD and its dilatation.

Figure 6. CBD proximal to the cholangiocarcinoma is measuring 0.7 cm. The patient still has her gallbladder.

Figure 7. Cholangiocarcima measuring 1.05 cm AP and 1.61 cm in width.

Figure 8. Lack of blood flow within the Cholangiocarcinoma.

Figure 9. CBD proximal and distal to the Cholangiocarcinoma.

Figure 10. CBD with the Cholangiocarcinoma.

Figure 11. Follow up CT scan. Biliary duct dilatation and the cholangiocarcinoma are both visualized on this image. On CT, the mass was 4 cm in length.

Diagnosis: Cholangiocarcinoma

The interpreting radiologist who read the ultrasound conceded our initial findings as well as recommended a follow up CT scan to help further evaluate if the mass was extrinsic or intrinsic in nature.

The CT scan showed a normal appearing gallbladder without cholelithiasis or other pathology.

Cholangiocarcinoma is a carcinoma of the bile duct.

When considering a list of possible differential diagnoses, choledocholithiasis was the first possibility.