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6 responses to “Bile duct obstruction”
Extra image of cbd with
Extra image of cbd with potential GI mass?
The gallbladder and
The gallbladder and cystic duct appear to be distended with anechoic content. The CBD is dilated with anechoic fluid without obvious calculi or mucoduct.
The pancreas is swollen and asymmetrical with heterogeneous parenchyma and possible early mineralization. This may suggest acute to chronic pancreatitis with fibrosis or neoplasia. Enlarged, swollen peripancreatic and periportal lymph nodes with subjective loss of normal width: length ratio are present. Echogenic peripancreatic fat is present.
I dont see an obvious GI mass but pancreatic pathology and adjacent lymphadenopathy are suspected to be causing the CBD dilation. Neoplasia is a primary rule out here with possibility of acute to chronic pancreatitis.
FNA of the enlarged lymph nodes and pancreas +/- liver would be ideal. Surgical biopsies and evaluation of the CBD +/- CBD flushing may be needed depending of the degree of cholestsasis and worsening clinical signs. A guarded prognosis is warranted.
The right adrenal nodule is
The right adrenal nodule is an incidental finding. Adenoma, lipogranuloma, or hyperplasia are probable based on appearance. I dont suspect neoplasia. Monitoring would be suggested pending the other issues.
You sure get interesting
You sure get interesting cases.
There is a mass effect just by the duodenal papilla. There also appears to be a neoplastic mass attached to the limb of the pancreas. I would need other views in differenty planes to fully confirm. Origin of the vasculature within the mass would also be helpful. The lymph nodes are beyond being reactive and are heavily infiltrated. They should be relatively easy to FNA for a final diagnosis. Unfortunately, either way this poor patient is beyond any favorable prognosis.
That’s very helpful, thank
That’s very helpful, thank you both very much.