PMC8247711_01
A 43-year-old man presented with porta hepatis inflammatory myofibroblastic tumor who presented with painless jaundice and pruritis. (a) axial pre-contrast CT image, (b) axial post-contrast CT image in arterial phase, (c) axial post-contrast CT image in porto venous phase and (d) axial post-contrast CT image in delayed phase show a heterogeneously enhancing mass at the porta hepatis [black arrow in (c)]. (e) Sagittal reformatted post-contrast CT image shows the mass compressing the common bile duct with upstream biliary dilatation. No vascular invasion was identified. The pancreas and liver were normal.
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F1
CT examination of the abdomen was performed [Figure 1] and revealed diffuse dilatation of the intra-hepatic biliary system and the common bile duct (CBD), with a well-defined soft-tissue mass compressing the infero-posterior aspect of the CBD.
A 43-year-old man presented with porta hepatis inflammatory myofibroblastic tumor who presented with painless jaundice and pruritis. MRCP image shows diffuse dilatation of the intrahepatic biliary radicles and proximal common bile duct (CBD) with narrowing noted at the middle third of the CBD.
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F2
MRI and MRCP were done to further evaluate the mass and the biliary system [Figures 2 and 3].
A 43-year-old man presented with porta hepatis inflammatory myofibroblastic tumor who presented with painless jaundice and pruritis. (a) axial pre contrast MR image, (b) axial post-contrast MR image in the arterial phase, (c) axial post-contrast MR image in porto venous phase, and (d) axial post-contrast MR image in delayed phase show a heterogeneously enhancing mass at the porta hepatis. The mass is of intermediate T1 signal intensity with no fat component. The mass shows mild arterial enhancement with progressive enhancement throughout the delayed phases [thin white arrow]. (e) axial DWI image and (f) corresponding axial ADC image show mild diffusion restriction [bold arrow]. No vascular invasion was identified.
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F3
MRI and MRCP were done to further evaluate the mass and the biliary system [Figures 2 and 3].
A 43-year-old man presented with porta hepatis inflammatory myofibroblastic tumor who presented with painless jaundice and pruritis. (a) ERCP image after cannulation of the common bile duct (CBD) shows stricture at the middle third of the CBD with subsequent proximal CBD and intrahepatic biliary radicles diffuse. (b) ERCP image after stent placement.
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F4
ERCP and biopsy from the mass were performed, with placement of CBD stent [Figure 4].