Case 349:   Cholangiocarcinoma

Diagnostic Category:

Clinical Presentation:

58 year old woman with Hepatitis C.

US: Echogenic, mimicking hemangioma

Imaging Findings:

Ultrasound shows a heterogeneous, predominantly echogenic lesion in segment 2/3 of the liver. It is slightly vascular when interrogated with color Doppler.  Sonographic findings favor a hemangioma, however, note subtle perifocal edema ("halo") on the gray scale image, which is atypical for hemangioma and suggestive for metastasis. Also note slightly nodular hepatic contour suggestive of cirrhosis. Hemangiomas in cirrhosis are rare and echogenic lesons in cirrhosis need to be worked up further as HCC are the most common echogenic masses in cirrhosis.

Biopsy of this lesion showed cholangiocarcinoma. Compare to contrast CT of the liver for more specific imaging clues for cholangiocarcinoma.