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Biliary Inflammatory Pseudotumor: Imaging Features in Seven Patients

¹ Department of Radiology (AI), University of Pittsburgh Medical Center, Presbyterian-Shadyside (Presbyterian Campus), 200 Lothrop St., Pittsburgh, PA 15213.
² Department of Surgery, University of Pittsburgh Medical Center, Presbyterian-Shadyside (Presbyterian Campus), Pittsburgh, PA 15213.

View larger version (127K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —48-year-old woman with jaundice and suspected cholangiocarcinoma. Biliary inflammatory pseudotumor confirmed at right trisegmentectomy. Sonogram shows subtle isoechoic lesion at duct bifurcation (arrows).

View larger version (111K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —48-year-old woman with jaundice and suspected cholangiocarcinoma. Biliary inflammatory pseudotumor confirmed at right trisegmentectomy. Portal venous inflow phase image of triphasic contrast-enhanced CT shows poorly defined enhancing lesion at duct bifurcation (arrow) and moderate intrahepatic biliary duct dilatation.

View larger version (111K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1C —48-year-old woman with jaundice and suspected cholangiocarcinoma. Biliary inflammatory pseudotumor confirmed at right trisegmentectomy. Hepatic phase CT image shows enhancing lesion at duct bifurcation (arrow).

View larger version (110K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1D —48-year-old woman with jaundice and suspected cholangiocarcinoma. Biliary inflammatory pseudotumor confirmed at right trisegmentectomy. Delayed phase CT image shows contrast retention within hilar lesion (arrow).

View larger version (134K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1E —48-year-old woman with jaundice and suspected cholangiocarcinoma. Biliary inflammatory pseudotumor confirmed at right trisegmentectomy. Thick-slab MR cholangiopancreatography image shows biliary obstruction at bifurcation (arrows).

View larger version (128K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1F —48-year-old woman with jaundice and suspected cholangiocarcinoma. Biliary inflammatory pseudotumor confirmed at right trisegmentectomy. ERCP image, which corresponds to E, obtained during stent placement shows focal hilar biliary stricture.

View larger version (135K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —42-year-old woman with presumed Klatskin's tumor. Infiltrating biliary pseudotumor was diagnosed at surgical resection after adjuvant chemotherapy. Hepatic phase CT image shows infiltrating tumor along encased and compressed right portal vein (arrows).

View larger version (99K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —42-year-old woman with presumed Klatskin's tumor. Infiltrating biliary pseudotumor was diagnosed at surgical resection after adjuvant chemotherapy. Axial PET/CT image shows 18F-FDG activity along course of right portal vein (arrows). Left percutaneous biliary catheter (arrowhead) is in place.

View larger version (106K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2C —42-year-old woman with presumed Klatskin's tumor. Infiltrating biliary pseudotumor was diagnosed at surgical resection after adjuvant chemotherapy. Coronal PET/CT image shows linear 18F-FDG uptake within right lobe (arrows). Internal biliary stent (arrowhead) is also in place.

View larger version (114K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —68-year-old man with jaundice and abdominal pain. Brushing cytology during ERCP showed cellular atypia. Inflammatory pseudotumor was diagnosed after right hepatectomy and biliary diversion. Hepatic phase image of triphasic CT examination shows isoenhancing biliary hilar soft tissue (arrow) and intrahepatic duct dilatation after stent placement.

View larger version (81K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —68-year-old man with jaundice and abdominal pain. Brushing cytology during ERCP showed cellular atypia. Inflammatory pseudotumor was diagnosed after right hepatectomy and biliary diversion. Delayed phase image shows mild retention of contrast material within hilar soft tissue (arrow).

View larger version (114K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3C —68-year-old man with jaundice and abdominal pain. Brushing cytology during ERCP showed cellular atypia. Inflammatory pseudotumor was diagnosed after right hepatectomy and biliary diversion. ERCP image shows short-segment malignant-appearing hilar stricture (arrows).

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