In case of intrahepatic biliary duct obstruction only without dilated common bile duct.
Is it diffuse including both hepatic lobes or localized including segmental or lobar distribution.
If it is segmental or lobar distribution, think immediately about cholangiocarcinoma.
If it is diffuse spreading along both hepatic lobes, go to the site of the porta-hepatis to see if there are any enlarged lymph nodes.
If there are enlarged lymph nodes, think about the cause which could be one of the following
-Metastases, search for the primary and lesions in other places.
-Or lymphoma, search for splenic affection or other lymph nodes in other places.
-Or TB or sarcoid.
If there are no enlarged lymph nodes in porta hepatis, go up to the site of union of both hepatic biliary ducts to form the common hepatic duct, in this site you can find a specific cholangiocarcinoma known as klatskin tumor affecting this region or you can diagnose Mirrizi's syndrome which is composed of a gall bladder calculus lodged in the neck of the gall bladder or cystic duct compressing common hepatic duct causing diffuse biliary radicle dilatation. .
A stone leading to calcular biliary obstruction.
A mass in the pancreatic head leading to malignant biliary obstruction.
In case you did not find a calculus or a pancreatic head mass, the role of radiology is terminated at this point writing the following in your report
Is it diffuse including both hepatic lobes or localized including segmental or lobar distribution.
If it is segmental or lobar distribution, think immediately about cholangiocarcinoma.
If it is diffuse spreading along both hepatic lobes, go to the site of the porta-hepatis to see if there are any enlarged lymph nodes.
If there are enlarged lymph nodes, think about the cause which could be one of the following
-Metastases, search for the primary and lesions in other places.
-Or lymphoma, search for splenic affection or other lymph nodes in other places.
-Or TB or sarcoid.
If there are no enlarged lymph nodes in porta hepatis, go up to the site of union of both hepatic biliary ducts to form the common hepatic duct, in this site you can find a specific cholangiocarcinoma known as klatskin tumor affecting this region or you can diagnose Mirrizi's syndrome which is composed of a gall bladder calculus lodged in the neck of the gall bladder or cystic duct compressing common hepatic duct causing diffuse biliary radicle dilatation. .
In case of presence of intrahepatic biliary duct dilatation in both hepatic lobes with evidence of dilated common bile duct.
Search along the course of the common bile duct for the cause of dilatation which could beA stone leading to calcular biliary obstruction.
A mass in the pancreatic head leading to malignant biliary obstruction.
In case you did not find a calculus or a pancreatic head mass, the role of radiology is terminated at this point writing the following in your report
( Extra hepatic biliary obstruction at the level of the distal part of the common bile duct for further evaluation by ERCP).
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