case_images: PMC8247659_01
case_images: A 58-year-old male patient presented with obstructive jaundice due to choledocho-nodal fistula. Endoscopic retrograde cholangiopancreatography with cholangiogram showing dilated upper common bile duct (CBD) and intrahepatic biliary radicles (short arrow) and a rounded lesion compressing the lower CBD (long arrow) consistent with the necrotic lymph node.
case_images: JCIS-11-32-g001.jpg
case_images: PMC8247659_01_JCIS-11-32-g001.jpg
case_images: F1
case_images: Endoscopic retrograde cholangiopancreatography (ERCP) was done, and on filling downstream, the dye besides showing dilated upper CBD and intrahepatic biliary radicles began to collect in a rounded fashion around the strictured middle-lower CBD [Figure 1].
case_images: A 58-year-old male patient presented with obstructive jaundice due to choledocho-nodal fistula. Endoscopic ultrasonography image showing partially cystic lesion (long arrow) with heterogeneous content around the common bile duct consistent with the necrotic lymph node, surrounding the inserted plastic stent (short arrow).
case_images: JCIS-11-32-g002.jpg
case_images: PMC8247659_01_JCIS-11-32-g002.jpg
case_images: F2
case_images: EUS showed partially cystic lesion with heterogeneous content around the CBD and surrounding the inserted plastic stent [Figure 2].
case_images: A 58-year-old male patient presented with obstructive jaundice due to choledocho-nodal fistula. Endoscopic ultrasonography with aspiration from the necrotic lymph node showing the yellow fluid consistent with bile. The bile source was confirmed on laboratory examination.
case_images: JCIS-11-32-g003.jpg
case_images: PMC8247659_01_JCIS-11-32-g003.jpg
case_images: F3
case_images: Figure 3]. Fluoroscopy confirmed the reduced lesion size after EUS aspiration [Figure 4].
case_images: A 58-year-old male patient presented with obstructive jaundice due to choledocho-nodal fistula. Fluoroscopy/ cholangiogram showing endoscopic ultrasonography needle aspirating the lesion with obvious size reduction (long arrow) in comparison to the size in Figure 1. Note the stent passing through the lesion (short arrow).
case_images: JCIS-11-32-g004.jpg
case_images: PMC8247659_01_JCIS-11-32-g004.jpg
case_images: F4
case_images: Figure 3]. Fluoroscopy confirmed the reduced lesion size after EUS aspiration [Figure 4].