Differential imaging features seen in the common causes of biliary obstruction

Differential imaging features seen in the common causes of biliary obstruction

A. Intrahepatic ductal dilatation (> 2 mm) with a normal common bile duct (CBD) suggests an intrahepatic mass or abnormality. Dilatation of the pancreatic duct typically localizes the obstruction to the pancreatic or ampullary level.

B. An abrupt transition from a dilated to a narrowed or obliterated CBD is more characteristic of a neoplasm or stone. Gradual tapering of the CBD at the pancreatic head is more typical of fibrosis associated with chronic pancreatitis, but chronic pancreatitis also can present as a focal mass, and biopsy may be required for differentiation.

C. Cholangiocarcinoma often arises around the liver hilum (Klatskin tumor). It should be suspected when abrupt biliary obstruction is present but no mass or stone is identified.

US: The primary mass is difficult to identify.

MDCT: Low-attenuating mass with mild delayed (10-20 minutes postinjection) peripheral enhancement is typical. Unlike HCC, cholangiocarcinoma usually encases but does not invade adjacent vessels.

MRI: Usually has low T1-w and high T2-w signal and progressive delayed enhancement caused by fibrous tissue. This can help determine the area to biopsy.

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