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Using CT and Cholangiography to Diagnose Biliary Tract Carcinoma Complicating Primary Sclerosing Cholangitis

William L. Campbell1, Mark S. Peterson1, Michael P. Federle1, Eduardo S. Siqueira2,3, Adam Slivka2, Luigi Grazioli1,4, Tomoaki Ichikawa1,5, James H. Oliver, III1, Tonsok Kim1,6 and Wei Li7

1 Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop St., Pittsburgh, PA 15213-2582.
2 Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA 15213-2582.
3 Present address: Real Hospital Português, Setor de Endoscopie (Endoscopie-Centro de Diagnóstico e Tratamento), Av. Portugal 163, Derby-Recife PE, 51010-010 Brazil.
4 Present address: Department of Radiology, University of Brescia, 1 via Valsabbina, Brescia 25100, Italy.
5 Present address: Department of Radiology, Yamanashi Medical University, Tamaho-cho, Nakakoma-gun, Yamanashi, Japan 409-3815.
6 Present address: Department of Radiology, Osaka University Medical School, 2-2 Yamadaoka, Suita Osaka, Japan 565-0871.
7 Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261.



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  		Fig. 1A. —Hilar cholangiocarcinoma with dominant high-grade strictures and progressive biliary ductal dilatation in 60-year-old woman. Endoscopic retrograde cholangiogram shows dominant high-grade strictures (arrows) of left and right hepatic ducts at bile duct bifurcation, with proximal intrahepatic biliary ductal dilatation (arrowheads).

 


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  		Fig. 1B. —Hilar cholangiocarcinoma with dominant high-grade strictures and progressive biliary ductal dilatation in 60-year-old woman. Follow-up endoscopic retrograde cholangiogram obtained 1-year later shows persistent dominant high-grade strictures (arrows) and progressive marked intrahepatic biliary ductal dilatation (arrowheads).

 


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  		Fig. 1C. —Hilar cholangiocarcinoma with dominant high-grade strictures and progressive biliary ductal dilatation in 60-year-old woman. Contrast-enhanced CT scans obtained 3 months after B show marked bilobar intrahepatic biliary ductal dilatation (arrows, C) and mass (arrow, D) at bile duct bifurcation.

 


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  		Fig. 1D. —Hilar cholangiocarcinoma with dominant high-grade strictures and progressive biliary ductal dilatation in 60-year-old woman. Contrast-enhanced CT scans obtained 3 months after B show marked bilobar intrahepatic biliary ductal dilatation (arrows, C) and mass (arrow, D) at bile duct bifurcation.

 


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  		Fig. 2A. —Cholangiocarcinoma of distal right hepatic duct with delayed contrast enhancement of mass detected on CT in 48-year-old man. Portal venous phase contrast-enhanced CT image shows mass (arrow) near liver hilum.

 


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  		Fig. 2B. —Cholangiocarcinoma of distal right hepatic duct with delayed contrast enhancement of mass detected on CT in 48-year-old man. Contrast-enhanced delayed phase (18-min) CT scan shows delayed contrast enhancement of tumor (arrow).

 


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  		Fig. 3A. —Common bile duct cholangiocarcinoma with progressive stricture in 71-year-old man. Endoscopic retrograde cholangiogram shows stricture (arrow) of proximal common bile duct.

 


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  		Fig. 3B. —Common bile duct cholangiocarcinoma with progressive stricture in 71-year-old man. Follow-up endoscopic retrograde cholangiogram obtained 19 months after A shows progressive malignant stricture (arrow).

 

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