PMC6180855_01
Axial portal-phase CT scan showing (a) a large amount of solid tissue in the left perirenal space and a smaller amount on the contralateral side (red arrows) and (b) a partial stenosis of the common bile duct owing to hypervascular eccentric tissue (white arrow). (c) Coronal portal-phase CT image showing left perirenal (red arrow) and peribiliary localization (white arrow).
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Similar findings were detected also in the right perirenal space (Figure 1a,c). CT images also revealed a partial stenosis of the common bile duct, with intrahepatic bile duct ectasia owing to hypervascular eccentric tissue (Figure 1b,c).
(a) Axial portal-phase CT scan performed after 3 months of medical therapy shows a marked reduction in size of the perirenal tissue on both sides (red arrows). (b) Coronal portal-phase CT image showing a similar reduction in size of the peribiliary tissue (white arrow); a residual ectasia of intrahepatic bile ducts was observed.
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Unexpectedly, on venous phase images, the perirenal tissue showed a remarkable reduction on the left side and had almost disappeared on the right side (Figure 2a). The peribiliary tissue had equally decreased in size and thickness (Figure 2b).
(a) Axial portal-phase CT scan performed 1 year later showing new solid tissue surrounding the right renal pelvis and calices (red arrow). (b) Coronal delayed-phase CT image confirming the presence of solid tissue infiltrating the renal pelvis (red arrow).
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The treatment was then discontinued in accordance with the patient's decision. 1 year later, both the left perirenal and peribiliary tissues demonstrated no progression and remained clinically stable on off-treatment; however, new tissue was visible surrounding the right renal pelvis and the calices (Figure 3a,b).