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Papillary Neoplasms of the Bile Duct That Mimic Biliary Stone Disease¹

¹ From the Departments of Radiology (J.H.L., J.W.L., H.K.L.) and Gastroenterology (K.T.L., J.K.L.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-ku, Seoul, Korea 135-710; and the Departments of Internal Medicine (M.H.K., S.S.L.) and Radiology (T.K.K., M.G.L.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. Presented as an education exhibit at the 2001 RSNA scientific assembly. Received February 19, 2002; revision requested April 23; final revision received July 12; accepted July 15. Address correspondence to J.H.L. (e-mail: jhlim@smc.samsung.co.kr).

Papillary tumors of the bile duct are intraductal tumors with innumerable minute, frondlike papillary projections. These tumors may be either fixed to or detached from the bile duct wall. However, because the papillary projections on the surface of papillary tumors are long and slender, the tumors are friable and slough easily. The sloughed tumor fragments may float within the bile ducts, resulting in intermittent partial biliary obstruction and mimicking bile duct stones at clinical examination and at ultrasonography (US), computed tomography (CT), and cholangiography. A tumor manifests radiologically as thickening and irregularity of the bile duct wall or as a fixed or sloughed intraductal mass. A nonshadowing intraductal echogenic cast seen at US, an intraductal noncalcified soft-tissue mass with asymmetric wall thickening seen at CT, and an intraductal mass with a papillary surface and a serrated bile duct margin seen at cholangiography are all appearances that suggest a papillary tumor and may be helpful in differentiating a tumor from a bile duct stone.

© RSNA, 2003

Index Terms: Bile duct radiography, 76.1222 • Bile ducts, calculi, 76.289 • Bile ducts, CT, 76.1211 • Bile ducts, neoplasms, 76.3192, 76.321 • Bile ducts, stenosis or obstruction • Bile ducts, US, 76.1298

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