Fig. 1. (A) Cross-sectional computed tomography (CT) imaging demonstrating an atrophic pancreas with a cystic neoplasm in the pancreatic head, measuring 1.3 cm × 1.3 cm (white asterisk). (B) Coronal magnetic resonance imaging (MRI) imaging demonstrated a prominent dilated pancreatic duct, measuring 9 mm, which tapered in caliber at the pancreatic head (arrow). (C) Additionally, the proximal dilated intrapancreatic duct demonstrated increased T1 and decreased T2 signals within the duct in the region of the dilated pancreatic head (red asterisk), suggesting debris or mucin, with more simple-appearing T2 bright fluid in the more proximal duct. (D) Cross-sectional CT imaging demonstrating significant biliary dilatation, particularly of the left lobe intrahepatic biliary radicles. At the level of the common hepatic duct upstream from the cystic duct insertion is a circumferential mass (black arrow). (E) Cross-sectional MRI imagining confirmed a circumferential mass, which was hyper-enhanced (white arrowhead) and retained contrast on delayed imaging, consistent with cholangiocarcinoma. (F) The mass (white arrowhead) measured up to 11 mm in diameter and extended to the hepatic hilum where it extended into the left hepatic duct just beyond the secondary to a biliary radical duct.

Ann Hepatobiliary Pancreat Surg 2021;25:556-61 https://doi.org/10.14701/ahbps.2021.25.4.556

© 2021 Ann Hepatobiliary Pancreat Surg