Presentation
Obstructive jaundice, epigastric pain
Patient Data
Marked atrophic changes of segments II and III of liver are seen with duct dilatation.
Remaining segments are of normal size.
There is dilation of the intrahepatic ducts, common hepatic duct, cystic duct, gall bladder (12 x 4 cm in diameter) and upper part of common bile duct (16 mm in maximum diameter) to the level of pancreatic head. The distal common bile duct is not dilated and shows wall enhancement
Sub centimeter lymph nodes are seen near the pancreatic head. The largest measures 7 mm in short diameter.
Case Discussion
ERCP guided biopsy confirmed common bile duct neoplasm and STENT was placed.
The biliary ducts dilatation and presence of portal vein branches in the markedly shrunken and small segments (II and III) of liver excludes the diagnosis of agenesis of the left hepatic lobe where the vascular branches are not formed and the biliary channels are not dilated.
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