case_images: PMC9709184_01
case_images: Magnetic resonance cholangiography shows a filling defect of the left hepatic duct (arrow) (a); cholangioscopy confirms the pedunculated lesion (b) which was treated by left hepatectomy and excision of the biliary confluence (c).
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case_images: PMC9709184_01_10.1177_26317745221139735-fig1.jpg
case_images: fig1-26317745221139735
case_images: A significant dilatation of the left biliary ducts due to the presence of a protruding biliary lesion with contrast enhancement and obstructing the left hepatic duct were evident on magnetic resonance cholangiopancreatography (MRCP) [Figure 1(a)]. POCS (SpyGlass DS, Boston Scientific, USA) showed a protruding lesion with an adenomatous appearance [Figure 1(b)] originating from the left hepatic duct and invading the proximal common bile duct; the biliary confluence was involved by the lesion without extension into the right sectorial ducts. Left hepatectomy with resection of the biliary confluence [Figure 1(c)] was performed.
case_images: PMC9709184_02
case_images: Magnetic resonance cholangiography shows a filling defect the common bile duct (arrow) (a); cholangioscopy confirms the intrabiliary lesion (b); surgery required left hepatectomy and resection of the biliary confluence (c).
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case_images: MRCP [Figure 2(a)] showed no biliary stones but confirmed the presence of tissue protruding into the mid common bile duct. Boston Scientific, USA) showed a protruding polypoid lesion with a fibrotic aspect originating from the left hepatic duct and invading the biliary confluence [Figure 2(b)]. Left hepatectomy with resection of the biliary confluence [Figure 2(c)] was performed.
case_images: PMC9709184_03
case_images: Magnetic resonance cholangiography shows a cyst of liver segment IV (arrowhead) and common bile duct filling defect (arrow) (a) as confirmed from cholangioscopy (b); left hepatectomy obtained cyst removal together with its biliary protrusion (arrow) (c).
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case_images: MRCP [Figure 3(a)] and computed tomographic (CT) scan showed right and left intra-hepatic radicles dilatation and an 8 x 6 x 6 cm complex cyst of segment IVb with contrast enhancement and suspicious appendix filling the left hepatic duct. POCS (SpyGlass DS, Boston Scientific, USA) diagnosed a polypoid lesion with a smooth and normal mucosa [Figure 3(b)], protruding from the left hepatic duct into the proximal common bile duct, without involvement of the biliary confluence; biopsies were not performed due to the normal appearance of the mucosa. Based on the cholangioscopy, a left hepatectomy [Figure 3(c)] was performed preserving the biliary confluence; the intrabiliary appendix of the cyst was easily extracted together with the left liver lobe.
case_images: PMC9709184_04
case_images: Magnetic resonance cholangiography and multiple bile ducts filling defects (a); cholangioscopy shows papillary lesion involving the biliary confluence (b) and the distal common bile duct.
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case_images: PMC9709184_04_10.1177_26317745221139735-fig4.jpg
case_images: fig4-26317745221139735
case_images: A 66-year-old male was admitted to the hospital due to epigastric pain, fever and rising LFTs; CT scan and MRCP showed multiple intra and extra-hepatic filling defects compatible with stones with diffuse bile tree dilation [Figure 4(a)]. Cholangioscopy (SpyGlass DS, Boston Scientific, USA) was performed and showed multifocal protruding papillary lesions in the distal common bile duct and in the biliary confluence [Figure 4(b)] involving also the right intra-hepatic ducts.