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CT Findings of Cholangiocarcinoma Associated with Recurrent Pyogenic Cholangitis

Jung Hoon Kim1, Tae Kyoung Kim2, Hyo Won Eun3, Jae Young Byun4, Moon-Gyu Lee5, Hyun Kwon Ha5 and Yong Ho Auh6

1 Department of Radiology, Soonchunhyang University Hospital, 657 Hannam-Dong, Youngsan-Ku, Seoul, South Korea 140-743.
2 Medical Imaging, Toronto General Hospital, University Health Network, Toronto, ON, Canada.
3 Department of Diagnostic Radiology, College of Medicine, Ewha Womans University, Seoul, South Korea.
4 Department of Diagnostic Radiology, Kangnam St. Mary's Hospital College of Medicine, The Catholic University of Korea, Seoul, South Korea.
5 Department of Diagnostic Radiology, Asan Medical Center, Seoul, South Korea.
6 Department of Radiology, Cornell University Weill Medical College, New York, NY.


Figure 1
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  		Fig. 1A —Peripheral cholangiocarcinoma associated with recurrent pyogenic cholangitis in 69-year-old man who complained of abdominal pain, fever, and leukocytosis. He has history of recurrent attacks of cholangitis and had previously undergone cholecystectomy because of gallstone. Unenhanced CT scan shows hepatolithiasis in right intrahepatic duct (arrowheads) with severe atrophy in posterior segment of right lobe.

 

Figure 2
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  		Fig. 1B —Peripheral cholangiocarcinoma associated with recurrent pyogenic cholangitis in 69-year-old man who complained of abdominal pain, fever, and leukocytosis. He has history of recurrent attacks of cholangitis and had previously undergone cholecystectomy because of gallstone. Contrast-enhanced CT scan at same level shows luminal narrowing of right portal vein (arrowheads).

 

Figure 3
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  		Fig. 1C —Peripheral cholangiocarcinoma associated with recurrent pyogenic cholangitis in 69-year-old man who complained of abdominal pain, fever, and leukocytosis. He has history of recurrent attacks of cholangitis and had previously undergone cholecystectomy because of gallstone. Contrast-enhanced CT scan obtained 16 mm below A during hepatic artery phase shows thick and lobulated enhancement at periphery of mass during arterial phase. This mass shows markedly hypoattenuated, septumlike linear structure and slightly hyperattenuated area. Diagnosis of cholangiocarcinoma was made at percutaneous liver biopsy.

 

Figure 4
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  		Fig. 2A —Peripheral cholangiocarcinoma associated with recurrent pyogenic cholangitis in 65-year-old-man who complained of abdominal pain, fever, and leukocytosis. He has history of recurrent attacks of cholangitis and Opisthorchis sinensis infestation. Contrast-enhanced CT scan obtained during hepatic artery phase shows severe atrophy in left lobe of liver.

 

Figure 5
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  		Fig. 2B —Peripheral cholangiocarcinoma associated with recurrent pyogenic cholangitis in 65-year-old-man who complained of abdominal pain, fever, and leukocytosis. He has history of recurrent attacks of cholangitis and Opisthorchis sinensis infestation. Contrast-enhanced CT scan obtained during portal venous phase also shows severe atrophy in left lobe of liver. Masslike lesion within atrophic left lobe (arrows) has thin enhancement at periphery on both arterial phase (A) and portal phase.

 

Figure 6
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  		Fig. 2C —Peripheral cholangiocarcinoma associated with recurrent pyogenic cholangitis in 65-year-old-man who complained of abdominal pain, fever, and leukocytosis. He has history of recurrent attacks of cholangitis and Opisthorchis sinensis infestation. CT scan obtained 8 mm below B shows obliteration of left portal vein (arrowheads). Diagnosis of cholangiocarcinoma was made at surgical resection.

 

Figure 7
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  		Fig. 3A —Peripheral cholangiocarcinoma associated with recurrent pyogenic cholangitis in 56-year-old-woman who complained of abdominal pain, fever, jaundice, leukocytosis, and hyperbilirubinemia. She has a history of recurrent attacks of cholangitis. Initial contrast-enhanced CT scan performed at another institution shows large, peripheral, enhanced, hypoattenuated mass in right lobe (arrows). Aspiration confirmed mass as abscess. Atrophied left lobe shows enhancement with intrahepatic duct dilatation but no definite mass.

 

Figure 8
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  		Fig. 3B —Peripheral cholangiocarcinoma associated with recurrent pyogenic cholangitis in 56-year-old-woman who complained of abdominal pain, fever, jaundice, leukocytosis, and hyperbilirubinemia. She has a history of recurrent attacks of cholangitis. Five-month follow-up contrast-enhanced CT scan shows complete resolution of hepatic abscess in right lobe and newly developed hypoattenuated mass (arrowheads) and slightly hyperattenuated area in left lobe. Note severe atrophy of lateral segment of left lobe and concomitant narrowing of left portal vein (arrow). Diagnosis of cholangiocarcinoma was made at surgical resection.

 

Figure 9
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  		Fig. 4A —Hilar cholangiocarcinoma associated with recurrent pyogenic cholangitis in 61-year-old-man who complained of abdominal pain, fever, jaundice, leukocytosis, and hyperbilirubinemia. He has history of recurrent attacks of cholangitis and Opisthorchis sinensis infestation. Contrast-enhanced CT scan of superior part of liver shows severe atrophy in lateral segment of left lobe of liver and obliteration of left portal vein (arrowheads).

 

Figure 10
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  		Fig. 4B —Hilar cholangiocarcinoma associated with recurrent pyogenic cholangitis in 61-year-old-man who complained of abdominal pain, fever, jaundice, leukocytosis, and hyperbilirubinemia. He has history of recurrent attacks of cholangitis and Opisthorchis sinensis infestation. CT scan 24 mm below A shows narrowing and enhanced, focal, thickened wall of right main bile duct (arrows) with dilation of intrahepatic duct. Hilar cholangiocarcinoma was confirmed at percutaneous transhepatic choledochoscopy-guided biopsy.

 

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