Current Case:
72-years old lady presented with jaundice. MRI (they didn't do an MRCP - cannot you believe it) showed a hilar lesion, likely a cholangiocarcinoma (arrows in Fig. 1).
PET-CT (Fig. 2) showed no uptake in the hilar lesion (A), but one lesion in segment 8 (arrow in B) showed uptake. This was retrospectively seen on the MRI as a focal area of restricted diffusion (arrow in C) and enhancement (arrow in D).
She was stented. Endoscopic brush biopsy was negative.
The patient was sent for an image guided biopsy. USG did not show the segment 8 lesion, so she was sent for a CT guided biopsy.
The lesion wasn't well seen on the plain scan, but after giving intravenous contrast, the lesion was seen, ill-defined, in segment 8 (Fig. 3), corresponding to the area of uptake on the PET. I decide to use the two biliary radicles (arrowheads on PET) as my markers (arrowheads on contrast CT). However, the lung was in the way.
