GI Radiology > Biliary > Bile Ducts > Neoplastic > Secondary

Biliary Tract Neoplasms

Secondary Neoplasms

  1. Pathogenesis:
  • Secondary neoplasms may cause biliary obstruction. Possible sources include (top to bottom):
     
    • Hepatocellular carcinoma.
       
    • Pancreatic carcinoma.
       
    • Ampullary tumor: occur at the ampulla of Vater and originate from the bile duct, pancreas, or duodenum.
       
    • Periampullary duodenal tumors.
  1. Radiographic findings:
  • Hepatocellular carcinoma
     
  • Pancreatic carcinoma
     
    • US: in 95% of cases, a low echogenicity mass is shown causing bile duct obstruction.

    • Note hypoechoic mass ahead of pancreas (arrow).

    • On CT, the following will likely be apparent: bile duct and pancreatic duct dilation (double duct sign); abrupt, focal, irregular stricture of the common biliary duct; bile duct encasement by direct extension or metastasis to peribiliary nodes.

    • CT shows pancreatic head mass (arrow).

    • The diagram below shows a typical appearance of pancreatic carcinoma on ERCP.
  • Ampullary tumor
     
    • Biliary dilation is seen proximal to the tumor.
       
    • Figures: Choledocholithiasis and ampullary carcinoma. (A) ERCP shows stones floating in the lumen of the common bile duct and tumor protruding from the wall of the distal common bile duct (arrow).

    • A                                  

    • (B) CT shows dilated intrahepatic bile ducts due to common bile duct obstruction. (C) CT shows tumor surrounded by contrast material in dilated distal common bile duct (arrow).
    •         
      B                                                                     C                                                            

 

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