63-year-old male with a history of lymphoma and positivity in the duodenum on PET/CT scan who presents with elevated LFTs. ABDOMEN:LIVER, BILIARY TRACT: There is marked extrahepatic and moderate intrahepatic biliary ductal dilation most pronounced involving the common bile duct to the level of an enhancing distal common bile duct mass which appears to extend minimally beyond the level of the ampulla into the 2nd portion of the duodenum, lesion measures 1.5 x 1.1 cm (36; series 9) and correlates to the FDG avid focus seen on prior PET imaging. Simple cyst in segment IVB of the liver.SPLEEN: No significant abnormality noted.PANCREAS: Mildly prominent pancreatic duct.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Exophytic simple cysts in interpolar region of the left kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Enhancing distal common bile duct mass, which appears to extend minimally beyond the level of the ampulla into the 2nd portion of the duodenum, measuring 1.5 x 1.1 cm (36; series 9). BONES, SOFT TISSUES: No significant abnormality noted.
1.5 cm distal common bile duct mass, with associated marked extrahepatic and mild to moderate intrahepatic biliary ductal dilation. Lesion extends to level of ampulla with apparent minimal extension into the second portion of the duodenum with mild dilation of the duodenum proximally. These findings are suspicious for a primary cholangiocarcinoma with differential considerations including an ampullary malignancy or duodenal neoplasm. Further characterization with ERCP/histologic sampling recommended. 