華山論劍-專業案例挑戰/Case 2015-006

Date: 30 Sep. posted by 陳溢松/李青泰/曾政豪醫師學術天地

Answer of Case 2015-007

Hyperbilirubinemia in progression was noted after PTCD done. MRCP (Fig.3) was arranged and showed right IHD dilatation and hilum stricture. ERCP with cholangioscopy (SpyGlass™) was arranged. Cholangioscopy (SpyGlass™) showed fragile and swelling mucosa of common hepatic duct. The scope, however, could not pass the stricture site. Biopsy was done and pathology finally reported squamous cell carcinoma(metastatic). PTCD revision was done in the meantime. Hyperbilirubinemia was gradually improved. Patient was discharged with PTCD.

From this case, we learned that biliary tract obstruction might be the first sign of liver metastasis before we have image evidence.

Figure 3.

Final Diagnosis:

Hyperbilirubinemia, tumor obstruction related