PMC5602881_01
MRI T2 weighted image. A tumor extending from the hepatic hilum to left hepatic duct (arrow) with a complete obstruction of the bile duct confluence, and separation of B1, B2, B3 and B4.
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Magnetic resonance imaging (MRI) showed the tumor extending from the hepatic hilum to the left hepatic duct, with complete obstruction of the left hepatic duct and separation of B1, B2, B3 and B4 (Fig. 1).
Dynamic contrast enhanced MRI of the artery phase showed a small defect in the left portal vein (arrow).
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The MRI also showed a small defect at the left portal vein (Fig. 2).
Preoperative endoscopic retrograde cholangiopancreatography showed a small defect in the hepatic hilum (arrow) and no enhancement of the left hepatic duct.
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Endoscopic retrograde cholangiopancreatography (ERCP) showed a small defect at the hepatic hilum and no enhancement of the left hepatic duct (Fig. 3).
Intraoperative cholangiography revealed a crab claw-like filling defect in the left hepatic duct (arrow).
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Intraoperative cholangiography revealed a crab claw-like filling defect at the left hepatic duct (Fig. 4); this suggested that the tumor in the bile duct was tumor thrombus floating in the left hepatic duct, rather than infiltration into the bile duct.
The resected specimen. Portal vein tumor thrombus in the left portal vein (arrow) (A) and bile duct tumor thrombus in the left hepatic duct (arrowhead) (B).
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This finding led to a diagnosis of mass-forming ICC with PVTT and BDTT (Fig. 5A and B).