0:01

This is a patient in his late 80s, patient

0:03

who presents with, who was found to have

0:06

obstructive liver function tests in his

0:07

lab values, and they got a non-contrast CT.

0:10

They couldn't give intravenous

0:11

contrast due to renal insufficiency.

0:15

And so, scrolling through these sets of

0:17

images, I've windowed them a little bit

0:19

to sort of show you some of the findings.

0:22

We can see in the liver that there

0:23

are dilated bile ducts, the left

0:25

hepatic duct, ducts are dilated.

0:27

Some of the right hepatic ducts are dilated.

0:29

You can see that posteriorly

0:30

here, anteriorly here.

0:31

Everything is quite dilated.

0:34

And if you were just to follow it downwards,

0:36

it looks dilated at its confluence.

0:37

The common hepatic duct looks dilated as

0:40

well and looks dilated up to about this

0:42

portion here and beyond that, oh, it gets

0:45

very difficult to see the bile duct.

0:48

So presumably, somewhere between here

0:52

and here, where you can kind of see the

0:54

common bile duct again, there's some sort

0:56

of abnormality that is causing, causing

0:59

obstruction of these bile ducts, but

1:00

very difficult to delineate on this exam.

1:03

So the patient then got an MRI exam.

1:06

This was also done without intravenous contrast.

1:09

However, the abnormality

1:10

uh, it's a little bit more apparent on this one.

1:13

And so we start off with our T2-weighted images,

1:15

and we can see that the bile ducts are dilated,

1:18

very easy to see on the T2-weighted images.

1:21

As we scroll downwards, the confluence is

1:23

dilated, the common hepatic duct is dilated.

1:25

Here we start to see some

1:26

of the cystic duct as well.

1:28

That looks like it's distended, some bile

1:30

in the, uh, gallbladder that's layering.

1:33

And right around here, we're going

1:35

to start to see something, and the

1:38

common bile duct here looks normal.

1:40

So there is some sort of mass, this sort of T2

1:43

signal mass, sort of relatively hypointense

1:46

mass to intermediate signal mass that is

1:49

resulting in this biliary ductal obstruction.

1:53

Looking at it on the coronals, you

1:55

can see right over here beautifully.

1:58

dilated bile ducts and a very discrete mass

2:02

that's emanating from the distal extrahepatic

2:06

biliary tree, probably really at a confluence

2:08

of the common hepatic and common bile ducts.

2:11

And so this is another good look

2:13

for a potential cholangiocarcinoma.

2:16

Of course, you would need

2:17

histology to confirm this.

2:20

The reason I wanted to show this

2:21

case is this is another example of

2:24

this turned out to be a cholangiocarcinoma,

2:25

and this is another example of a distal

2:26

cholangiocarcinoma, but its appearance is a

2:28

little bit different than the case that was

2:31

shown a little bit earlier, in that it's not

2:34

necessarily manifesting as just a region of

2:36

thickening and enhancement involving

2:40

the distal common bile duct, but there's certainly

2:42

a more, uh, mass-like component and some of

2:44

this looks almost polypoid in its appearance.

2:46

And so you can also have that appearance

2:49

with these cholangiocarcinomas.

2:51

And so this was a nice example

2:53

of what that could look like.