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Age: 94

Sex: Male

Indication: Jaundice

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Case #46


Findings

  • Extrahepatic and central intrahepatic biliary duct dilation with the visualized common bile duct measuring up to 16 mm in diameter
  • The distal common bile duct is obscured by bowel gas
  • Multiple hypoechoic liver masses, the largest of which measures up to 3.3 cm in the anterior aspect of the right hepatic lobe
  • Liver is enlarged, measuring 21.4 cm in craniocaudal span, with diffusely heterogeneous echotexture
  • Portal and hepatic veins are patent with antegrade flow
  • Cholecystectomy
  • Right kidney is partially obscured by bowel gas without evidence of hydronephrosis
  • Hypoechoic structure measuring up to 4.6 cm arising from the upper pole of the right kidney with posterior acoustic enhancement, compatible with a cyst
  • Pancreas is not well assessed due to overlying bowel gas
  • Visualized portions of the abdominal aorta are normal in caliber
  • No ascites


Diagnosis

Malignant biliary obstruction

Sample Report

Extrahepatic and central intrahepatic biliary duct dilation, which raises concern for a distal biliary obstruction. Given that the distal common bile duct and pancreas are not well assessed on this study due to bowel gas, recommend contrast-enhanced CT of the abdomen and pelvis for further assessment.

Multiple hypoechoic liver masses, concerning for metastatic disease.


Discussion

  • In most patients, ultrasound is very sensitive for detecting biliary duct dilation, but the distal common bile duct and ampulla are often difficult to evaluate due to overlying bowel gas
  • If an explanation for biliary duct dilation is not identified by ultrasound, further imaging with contrast-enhanced CT or MRCP should be pursued
  • Multiple hypoechoic (but not anechoic) liver masses are metastases until proven otherwise in an older adult



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