History of cholangiocarcinoma, presents for restaging. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology and size. There is severe intrahepatic ductal dilatation which abruptly terminates at Klatskin's point (series 8/92), where there is a suspected mass lesion measuring 1.2 x 1.0 cm which progressively enhances (series 12/32), suspicious for cholangiocarcinoma. The more distal common bile duct appears normal in caliber.There is extensive intrahepatic bile duct wall thickening and postcontrast enhancement predominantly involving the right hepatic lobe which extends peripherally to several lobular mass lesions which demonstrate postcontrast heterogeneous and rim enhancement. Periductal hyperenhancement also seen. Right posterior portal vein not well seen, suspicious for thrombosis. The proximal right and common hepatic arteries are patent, the left hepatic artery is suboptimally visualized.The visualized hepatic veins are patent.Cholelithiasis within a normally distended gallbladder without specific evidence of acute inflammation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
Extensive intrahepatic ductal dilatation which tapers abruptly at Klatskin's point with focal lesion suspicious for cholangiocarcinoma. Extensive periductal enhancement and thickening predominantly involving the right hepatic lobe which extends to peripherally based heterogeneous enhancing/rim-enhancing lesions. The extent of periductal thickening and enhancement favors an infectious etiology, i.e., suppurative cholangitis with associated abscess formation. While an element of periductal infiltrating cholangiocarcinoma cannot be entirely excluded, considered less likely based on extent seen. Right posterior portal vein not well seen, suspicious for thrombosis.