0:01

This patient is a 60-year-old

0:02

male with abdominal pain.

0:05

A CT scan was obtained to further evaluate

0:07

the cause of the patient's symptoms.

0:10

As we scroll downwards, this was

0:11

performed with intravenous contrast.

0:14

We can see that the intrahepatic

0:16

bile ducts are dilated.

0:17

We can see them here, here, here, here.

0:19

So both the right and left

0:20

intrahepatic ducts are dilated.

0:22

They meet at their confluence from the

0:24

common hepatic duct, which is also dilated.

0:27

The cystic duct seems to be coming in over here.

0:28

So that's going to become the common

0:30

bile duct right after it joins.

0:31

It's a little bit of a low-lying

0:33

cystic duct, but joins common bile

0:36

duct looks quite dilated here.

0:38

And as you scroll downward, look at

0:39

that abrupt caliber change from here.

0:41

So I'm going to zoom up on just to make sure

0:44

you can see that properly from this to that.

0:50

The other thing I want you to notice

0:52

within the distal common bile duct, there

0:55

is increased enhancement of its lining,

0:57

which appears slightly thicker than

0:59

in other portions of the biliary tree.

1:01

The lining here is essentially imperceptible.

1:03

As you go downward, it's

1:04

thickened and it's enhancing.

1:08

Let's look at it on the coronal images.

1:10

Again, you can see the dilated biliary tree,

1:13

dilated biliary tree up here, and quite

1:17

an abrupt cutoff right over here with

1:20

a focal region of thickening and enhancement

1:23

involving the distal common bile duct.

1:25

So this finding is highly

1:28

concerning for a cholangiocarcinoma.

1:32

Now this instance is of a cholangiocarcinoma

1:35

occurring in the more distal common bile duct.

1:38

So I had mentioned cholangiocarcinomas.

1:40

We generally categorize them as

1:42

occurring in three locations.

1:44

Most commonly is in the hilum region.

1:47

The next location we tend to see them is

1:50

in the more distal common bile duct.

1:53

And it can just manifest as a region of

1:56

stricture, i.e., a segment where it just

2:00

thickens and enhances and it just sort

2:01

of strictures that region without a very

2:03

discreet, measurable, sort of thick mass

2:06

that we can just sort of put calipers on.

2:08

So I wanted to show this case as another

2:10

appearance of what a cholangiocarcinoma can look

2:13

like in the second most common location,

2:15

that is, these distal cholangiocarcinomas.