IS case 511: Malignant common bile duct stricture

Jacinto Camarena III, MD

University of Rochester

Imaging Sciences URMC 2010
Publication Date: 2010-09-10

History

Patient is an 81-year-old male with jaundice and elevated liver function tests.

Findings

See figures

Discussion

Common bile duct strictures can be due to many causes. The differential may be suggested at ERCP based on duct termination characteristics, margin appearance, and stricture length. Malignant etiologies like pancreatic cancer (most common) or cholangiocarcinoma are suggested when there is long segment involvement with abrupt termination and shouldered irregular margins. Alternatively, short segment strictures or strictures that demonstrate progressive tapering and smooth margins indicate a non-malignant cause such as chronic pancreatitis, inflammation secondary to choledocholithiasis, ischemia in post liver transplant patients, and cholangitis. These findings are not specific to the nature of the cause however. Park, et al. [1] noted considerable crossover in the radiologic appearance of malignant and benign CBD strictures. Ultimately, definitive diagnosis requires tissue sampling via ERCP or percutaneous transhepatic cholangiography.

References

  1. Park MS, Kim TK, Kim KW, et al. Differentiation of extrahepatic bile duct cholangiocarcinoma from benign stricture: findings at MRCP versus ERCP. Radiology. 2004 Oct;233(1):234-40. PMID: 15333766
  2. Choi SH, Han JK, Lee JM et al. Differentiating malignant from benign common bile duct stricture with multiphasic helical CT. Radiology. 2005 Jul;236(1):178-83. PMID: 15955859

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