0:01

So here we have a 66-year-old female

0:03

with abdominal pain, and an MRI was obtained.

0:06

I want to start off by showing the MRCP images.

0:09

And so if you look at the MRCP images, there's

0:11

a lot going on, but just sort of focusing

0:13

on portions of the liver that we do see.

0:17

And we'll just zoom up on some of these images.

0:19

You can see that duct over here is

0:21

dilated and then abruptly narrows.

0:24

There's a duct over here that's

0:25

dilated and abruptly narrows.

0:27

There's a duct over here that's

0:28

dilated and abruptly narrows.

0:30

And so you can see that over

0:31

here, a little bit over here.

0:34

And so kind of taking this all in,

0:38

there are really segmental regions of

0:39

biliary ductal dilatation in this liver.

0:41

And again, one of the entities

0:44

that often manifests with areas of

0:47

segmental biliary ductal dilatation

0:49

is primary sclerosing cholangitis.

0:51

If this is all you saw, you know, as a

0:52

case, you may think, "Oh, could this be a

0:54

case of primary sclerosing cholangitis?"

0:57

But obviously, you know, you

0:58

don't view images in isolation.

0:59

We'll look at everything else.

1:01

And so let's now go back to

1:03

some of our other sequences.

1:04

This is the T2-weighted image.

1:06

And we're certainly seeing

1:07

ducts that are dilated, right?

1:09

They're segmental ductal dilatation.

1:10

You can see it over here.

1:11

You can see it over here.

1:13

But in this instance, it's not really

1:15

strictures of the bile duct that's

1:17

causing it, but rather this is a liver

1:19

that contains numerous metastases.

1:21

And these are causing mass effect

1:23

on some of these bile ducts.

1:24

You can see this duct is dilated due to

1:26

a large metastasis over here and really

1:29

numerous metastases in this liver that

1:31

are resulting in multifocal regions

1:34

of intrahepatic ductal dilatation.

1:36

If you look even closer, you can see the

1:38

pancreatic duct is kind of dilated over

1:40

here, and there's a pancreatic neoplasm here.

1:43

So this turned out to be a pancreatic neoplasm,

1:46

adenocarcinoma with numerous liver metastases,

1:50

resulting in multifocal segmental regions

1:54

of intrahepatic ductal dilatation, a

1:56

finding which we often use to describe

1:58

primary sclerosing cholangitis, but

2:00

obviously can also occur with any entity

2:03

that causes mass effect upon the bile ducts.

2:05

In this instance, it was mass effect

2:08

from numerous liver metastases.