case_images: PMC11729543_01
case_images: Axial MRI slices in axial T2SE sequence (A), T1GRE with pre-contrast fat saturation (B), and post-contrast in arterial phase (C), portal (D), and late 5 min (E) where an endoluminal mass (short white arrows) is observed hypointense on T1, with intermediate-high signal on T2, and hypovascular impregnation, which occupies and dilates the lumen of the medial segmental biliary branch. Note the dilation of the intrahepatic bile duct in the other segments (long white arrows).
case_images: 0102-6720-abcd-37-e1848-gf01.jpg
case_images: PMC11729543_01_0102-6720-abcd-37-e1848-gf01.jpg
case_images: F1
case_images: There was no involvement of the confluence of the right secondary bile ducts (Figures 1-4).
case_images: Sagittal T2SE acquisition showing intraductal mass with a component in the common hepatic duct (black arrows) and extension toward the medial segmental intrahepatic biliary branch (white arrows).
case_images: 0102-6720-abcd-37-e1848-gf02.jpg
case_images: PMC11729543_01_0102-6720-abcd-37-e1848-gf02.jpg
case_images: F2
case_images: There was no involvement of the confluence of the right secondary bile ducts (Figures 1-4).
case_images: Post-contrast coronal T1 acquisitions showing luminal occupation of intrahepatic ductal branches by tumor mass (white arrowheads) (A) and the component that compromises the common hepatic duct (long black arrow) (B).
case_images: 0102-6720-abcd-37-e1848-gf03.jpg
case_images: PMC11729543_01_0102-6720-abcd-37-e1848-gf03.jpg
case_images: F3
case_images: There was no involvement of the confluence of the right secondary bile ducts (Figures 1-4).
case_images: T2 cholangiographic sequences with thick slab technique showing absence of representation of the common hepatic duct due to luminal obliteration by the mass of the common hepatic duct (black arrows) (A), and representation of the tumor endoluminal component in the medial segmental intrahepatic biliary branch as an irregular endoluminal filling defect (black arrowheads). Note the marked dilation of the remaining intrahepatic bile duct (long white arrows) and the common bile duct of normal caliber and signal distal to the tumor obliteration of the common hepatic duct (asterisks) (B).
case_images: 0102-6720-abcd-37-e1848-gf04.jpg
case_images: PMC11729543_01_0102-6720-abcd-37-e1848-gf04.jpg
case_images: F4
case_images: There was no involvement of the confluence of the right secondary bile ducts (Figures 1-4).
case_images: Percutaneous biliary drainage with endoscopic biliary prosthesis. (A) Right bile duct puncture. (B) Right bile duct cannulation. (C) Right bile duct dilation. (D) Drainage installation in the bile duct.
case_images: 0102-6720-abcd-37-e1848-gf05.jpg
case_images: PMC11729543_01_0102-6720-abcd-37-e1848-gf05.jpg
case_images: F5
case_images: Pulmonary artery angiography. (A) Overriding thrombus in the trunk of the pulmonary artery. The arrows show how the pulmonary arteries are not contrasted. (B) Occlusion of the left inferior lobar artery. The arrow shows how the left inferior lobar artery is not contrasted. (C and D) Angiography after bilateral mechanical fragmentation and thrombolysis with local and intravenous r-TPA shows contrast in both pulmonary arteries.
case_images: 0102-6720-abcd-37-e1848-gf06.jpg
case_images: PMC11729543_01_0102-6720-abcd-37-e1848-gf06.jpg
case_images: F6
case_images: A massive PE was diagnosed, and an urgent angiography was undertaken, showing a saddle embolus in the main pulmonary artery with occlusion of the left pulmonary lower lobar artery (Figures 6A and 6B). Low-dose r-TPA intravenous thrombolysis was also administered (Figures 6C and 6D).