Case 26:   Cholangiocarcinoma

Diagnostic Category:

Clinical Presentation:

64 year old man presents with abdominal pain.

CT: Mass-like, with vascular encasement

Imaging Findings:

Multiphase CT reveals a large central cholangiocarcinoma, confirmed by biopsy. The mass encases the left and right bile ducts, all hepatic veins, and the IVC. The middle hepatic vein is obliterated. Note the reactive subsegmental hypervascularity in segment six due to compression of the right porterior portal vein (arrowhead). No tumor thrombus is identified in the right portal vein. Note that equilibrium phase demonstrates only little peripheral enhancement after 10 minutes, representing only mild desmoplastic stroma reaction within the mass.