PMC8323408_01
Magnetic resonance cholangiopancreatography without contrast of the bile ducts: The
liver demonstrates intrahepatic duct dilation. The left hepatic duct measures 13 mm and
the right hepatic duct measures 12 mm. There is a filling defect in the proximal common
bile duct suggestive of a calculus. Contour of the bile ducts is irregular and
ragged.
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PMC8323408_01_10.1177_2050313X211035573-fig1.jpg
fig1-2050313X211035573
MRCP revealed left and right hepatic duct dilation and a filling defect in the proximal common bile duct suggestive of a calculus (Figure 1).
Endoscopic retrograde cholangiopancreatography showing the "Arrowhead sign" (red
arrows). The arrowhead appearance of the bile ducts is reflected by the decreased
arborization of the peripheral ducts and multiple intrahepatic biliary structures. The
rapid tapering of the intrahepatic ducts resulting to less acute branching patterns is
due to extensive periductal fibrosis.
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PMC8323408_01_10.1177_2050313X211035573-fig2.jpg
fig2-2050313X211035573
Subsequent endoscopic retrograde cholangiopancreatography (ERCP) was consistent with extensive periductal fibrosis (Figure 2).