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Pancreatic CT scan. General dilatation of the intrahepatic biliary tree and terminal common bile duct.
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CT scan was performed to discard a neoplastic obstruction and confirmed an intrahepatic biliary ductal dilatation (Fig. 1) and a dilatation of the distal bile duct with no luminal lesions (Fig. 2).
ERCP. Heterogeneous pancreatic parenchyma and pseudonodular appearance of the pancreatic head. Wirsung duct with no stenosis or obstructions. Common bile duct with normal caliber until the intrapancreatic portion where a highly suspicious of malignancy 2 cm irregular stenosis is seen.
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The MRCP, on the other hand, suggested the existence of a distal cholangiocarcinoma, because of the sudden typical stenosis in the distal CBD with a general dilatation of the upper bile ducts (Fig. 3).