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Image of the month
Image of the Month David M. Warshauer, Section Editor
Figure 1.
Figure 2.
Question: A 23-year-old Turkish female with a 1-year history of abdominal pain located in the right upper quadrant presented with an increase in pain, fever up to 40°C, and jaundice since the previous day. Physical examination revealed no further abnormalities. Laboratory examination showed abnormalities consistent with cholestasis. Upper abdominal ultrasonography and computerized tomography scan (Figure 1) showed a multicystic lesion in the right liver lobe with calcifications, extremely dilated intra- and extrahepatic bile ducts, and an irregular mass in the common bile duct (CBD). Bile stones were not seen. Because of a high suspicion of acute cholangitis, an emergency endoscopic retrograde cholangiopancreatography (ERCP) was performed. Cholangiography (Figure 2) also showed a massively dilated bile duct
system with an irregular mass apparently obstructing the CBD. The right intrahepatic bile duct system could not be visualized. What is the diagnosis? Look on page 1266 for the answer and see the Gastroenterology website (http:// www.gastrojournal.org) for more information on submitting your favorite image to Image of the Month. M. P. SCHWARTZ, M.D. M. SAMSOM, PH.D., M.D. Universitair Medisch Centrum Academisch Ziekenhuis Utrecht Utrecht, The Netherlands © 2001 by the American Gastroenterological Association
0016-5085/01/$35.00 doi:10.1053/gast.2001.29352
GASTROENTEROLOGY 2001;121:1039
Figure 1.
Figure 2.
Question: A 23-year-old Turkish female with a 1-year history of abdominal pain located in the right upper quadrant presented with an increase in pain, fever up to 40°C, and jaundice since the previous day. Physical examination revealed no further abnormalities. Laboratory examination showed abnormalities consistent with cholestasis. Upper abdominal ultrasonography and computerized tomography scan (Figure 1) showed a multicystic lesion in the right liver lobe with calcifications, extremely dilated intra- and extrahepatic bile ducts, and an irregular mass in the common bile duct (CBD). Bile stones were not seen. Because of a high suspicion of acute cholangitis, an emergency endoscopic retrograde cholangiopancreatography (ERCP) was performed. Cholangiography (Figure 2) also showed a massively dilated bile duct
system with an irregular mass apparently obstructing the CBD. The right intrahepatic bile duct system could not be visualized. What is the diagnosis? Look on page 1266 for the answer and see the Gastroenterology website (http:// www.gastrojournal.org) for more information on submitting your favorite image to Image of the Month. M. P. SCHWARTZ, M.D. M. SAMSOM, PH.D., M.D. Universitair Medisch Centrum Academisch Ziekenhuis Utrecht Utrecht, The Netherlands © 2001 by the American Gastroenterological Association
0016-5085/01/$35.00 doi:10.1053/gast.2001.29352
GASTROENTEROLOGY 2001;121:1039