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. 2017 Feb 15;56(4):401–407. doi: 10.2169/internalmedicine.56.7526

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The Internal Medicine is an Open Access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. To view the details of this license, please visit (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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Figure 1. — Radiographic images of the extrahepatic bile duct tumor. A-C: Coronal plane of computed tomography (CT) images. A precontrast CT image (A) shows the extrahepatic bile duct mass (arrow) and the dilated gallbladder (arrowhead). The intrahepatic and extrahepatic bile ducts are dilated. A large renal cyst is present in the left kidney. An arterial phase CT image (B) shows that the mass has slight and heterogeneous enhancement. A delayed phase CT image (C) shows that the mass is further enhanced. D-E: Magnetic resonance imaging shows that the mass is heterogeneous and somewhat hypointense on a T1-weighted image (D) and partially hyperintense (arrow) on a T2-weighted image (E). The hyperintense area probably corresponds to the largest tumor. F: Sagittal plane of the ultrasonography image. An intraductal nodule 7 cm in length with dilatation of the extrahepatic bile duct is seen. The nodule includes a hypoechoic lesion (arrowheads) that probably corresponds to the largest tumor of four polypoid lesions. G: Percutaneous transhepatic cholangiography. A filling defect is seen in the extrahepatic bile duct. The paucity of the transverse portion of the duodenum suggests intestinal malrotation. White bar, 2 cm in A, D-G.