Figure 3.

A 57 year old man with localised wall thickening of the bile duct. The patient initially presented with upper abdominal pain. Ultrasonography showed bile duct dilatation. He underwent endoscopic lithotripsy following an endoscopic retrograde cholangiography that showed a bile duct stone. (A) Cholangiography after endoscopic lithotripsy showed a stenosis in the distal portion of the bile duct (arrow). (B) A frame from the intraductal ultrasonogram showing the probe in the bile duct (BD) within the ultrasonographic field of view. Note the localised bile duct wall thickening (arrows) with the normal structure of the bile duct. The narrow dot at the margin of the frame was 1.0 mm in width. Endoscopic transpapillary bile duct biopsy showed no evidence of malignancy. (C) Three months later, cholangiography showed persistent stenosis (arrow). (D) A frame from the intraductal ultrasonogram showed wall thickening (arrows). It showed no interval change. Endoscopic transpapillary bile duct biopsy again showed no evidence of malignancy.