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ANASTOMOTIC STRICTURE

FIGURE 104-1

(A) Ultrasound image at porta hepatis shows dilatation of hepatic duct without normal tapering. No cause of obstruction was identified. HD, hepatic duct; PV, portal vein. (B–C) Endoscopic retrograde cholangiopancreatography (ERCP). Sphincterotomy was performed to facilitate access. Short-segment focal narrowing is seen at the anastomotic site (arrow) consistent with stricture. After balloon dilation, 2 plastic stents were placed.

ANASTOMOTIC STRICTURE AND STONES

FIGURE 104-2

(A–B) Biliary stenosis and distal stone. Magnetic resonance cholangiopancreatography (MRCP) shows high-grade stenosis at the anastomotic site (yellow arrow) resulting in proximal biliary dilatation. Notice abrupt distal cutoff due to an obstructing stone with typical convex margin (red arrow). (B) Percutaneous transhepatic cholangiography (PTHC) confirms stenosis (yellow arrow) and distal obstruction due to stone (red arrow).

STRICTURE AT HEPATICOJEJUNOSTOMY

FIGURE 104-3

(A–B) Stenosis at the hepaticojejunostomy. Coronal T2-weighted image shows focal stenosis at the hepaticojejunal anastomosis (arrow) and proximal dilatation. MRCP clearly depicts the focal stenosis (arrow) and resulting proximal dilatation. This anastomosis poses a challenge on MRCP, given its anatomic nature without a clear tubular luminal configuration.

BILIARY STRICTURE IN 11-YEAR-OLD BOY WHO UNDERWENT PARTIAL LT FOR BILIARY ATRESIA

FIGURE 104-4

Biliary stricture in 11-year-old boy who underwent partial liver transplant for biliary atresia. (A) MRCP shows intrahepatic biliary dilatation. Coronal T1-weighted postcontrast (hepatospecific). (B, C, and D) Contrast in ducts draining the upper portion of the graft (red arrow) but no excretion into ducts draining the lower part (yellow arrow). Notice the long-segment stricture proximal at the hepaticojejunostomy (blue arrow). (E–F) Delayed-phase coronal T1-weighted shows biliary-excreted hepatospecific contrast in duct proximal to stricture (red arrow), as well as passage of contrast into jejunal loop through hepaticojejunostomy (yellow arrow). (G–I) PTHC confirms long-segment stricture at the hepaticojejunostomy (blue arrow) successfully dilated with an internal/external biliary drainage catheter.

MULTIPLE BILIARY STRICTURES

FIGURE 104-5

(A–B) Multiple biliary stenosis. MRCP reveals multiple focal intrahepatic stenosis (arrows) secondary to biliary ischemia due to hepatic artery thrombosis. Notice resulting irregular configuration of the biliary tree. PTHC of the same patient confirms multiple stenoses (arrows) with proximal segmental dilatation.

FIGURE 104-6

(A–C) MRCP shows multiple dilated biliary ducts (yellow arrows) in a patient with ischemic-type intrahepatic biliary stenoses. Notice patent hepaticojejunostomy (arrowhead). Axial T1- and T2-weighted images show heterogeneous parenchymal signal intensity. Increased signal on T1-weighted image (asterisk) is due to biliary stasis. Of note is ...

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