PMC3896744_01
Magnetic resonance imaging findings on 22 February 2011. (A) Short inversion time inversion recovery image, showing a mildly dilated common bile duct. Heterogeneous isointense areas (white arrow) were observed in the distal portion of the common bile duct, suggesting common bile duct stones. (B) Magnetic resonance cholangiopancreatography, showing mild obstruction at the duodenal ampulla (short white arrow). The common bile duct and pancreatic duct were slightly dilated (long white arrows).
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F1
On 22 February 2011, abdominal magnetic resonance imaging (MRI) and magnetic resonance cholangiopancreatography (MRCP) showed a maximum common bile duct (CBD) diameter of 13 mm with an area of heterogeneous intensity signals in the distal portion of the CBD suggestive of CBD stones (Figure 1A), and normal intrahepatic bile ducts. There was mild obstruction at the duodenal ampulla (Figure 1B), liver cirrhosis, and enlargement of the spleen.
Magnetic resonance imaging findings on 25 April 2011. Magnetic resonance cholangiopancreatography, showing irregular hypointense areas in the common bile duct (white arrows) with obvious dilation of the distal bile ducts. G, gallbladder; L, liver.
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F2
The report of a follow-up MRCP performed at another hospital, at a time when the patient was asymptomatic, described nodular cirrhosis, enlargement of the gallbladder, mild dilation of the intra- and extrahepatic bile ducts, irregular areas of low signal intensity in the CBD that were interpreted as CBD stones (Figure 2), and a 1.1 cm diameter mass with clear borders in the lateral portion of the left lobe of the liver that was hypointense on T1-weighted images and slightly hyperintense on T2-weighted images. The consulted team (surgeon, radiation oncologist, medical oncologist, and radiologist) considered that the hepatic mass might be a benign nodule, and should be monitored.
Magnetic resonance imaging findings on 21 September 2011. (A) Short inversion time inversion recovery image, showing an irregular, isointense mass with unclear margins (short white arrows) in the left lobe of the liver. There was fluid around the pancreas (white arrows) indicating pancreatitis, and mild dilation of the intrahepatic bile ducts (long white arrow). (B) Short inversion time inversion recovery image distal to the plane of image (A), showing a dilated common bile duct with an isointense filling defect (white arrow).
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F3
Abdominal MRI and MRCP on the day after admission showed cholecystitis, gallbladder stones, a mass in the left lobe of the liver with unclear margins that was isointense on short inversion time inversion recovery sequences (Figure 3A), filling defects in the CBD suggestive of stones (Figure 3B), dilation of the intra- and extrahepatic bile ducts, pancreatitis, and liver cirrhosis.