26361640 Visualization

A 68 Age - year Age - old Age female Sex nonsmoker History , nondrinker History with a medical history of hypertension Disease_disorder presented Clinical_event with new Detailed_description - onset Detailed_description painless Detailed_description jaundice Sign_symptom and pruritus Sign_symptom , a three Duration - month Duration history of 9.9 Lab_value kg Lab_value weight Sign_symptom loss Sign_symptom and chronic Detailed_description diarrhea Sign_symptom with four Lab_value to Lab_value five Lab_value loose Lab_value bowel Diagnostic_procedure movements Diagnostic_procedure per Detailed_description day Detailed_description .
Medications Medication included vitamin Medication D Medication , amlodipine Medication and eprosartan Medication .
Physical Diagnostic_procedure examination Diagnostic_procedure was normal Lab_value except for jaundice Sign_symptom and muscle Disease_disorder wasting Disease_disorder .
Recent colonoscopy Diagnostic_procedure had been normal Lab_value .
Total Detailed_description and direct Detailed_description bilirubin Diagnostic_procedure levels were 6.84 Lab_value mg/dL Lab_value ( 116.96 Lab_value μmol/L Lab_value ) and 9.18 Lab_value mg/dL Lab_value ( 156.98 Lab_value μmol/L Lab_value ), respectively.
Other results included an international Diagnostic_procedure normalized Diagnostic_procedure ratio Diagnostic_procedure of 1.0 Lab_value , alanine Diagnostic_procedure aminotransferase Diagnostic_procedure level 247 Lab_value U/L Lab_value (normal <33 U/L), aspartate Diagnostic_procedure aminotransferase Diagnostic_procedure level 139 Lab_value U/L Lab_value (normal <32 U/L) and alkaline Diagnostic_procedure phosphatase Diagnostic_procedure level 524 Lab_value U/L Lab_value (normal 35 to 104 U/L).
Viral Diagnostic_procedure hepatitis Diagnostic_procedure serologies Diagnostic_procedure , and antimitochondrial Diagnostic_procedure antibody Diagnostic_procedure and anti Diagnostic_procedure - smooth Diagnostic_procedure muscle Diagnostic_procedure antibody Diagnostic_procedure tests were negative Lab_value .
Her alpha Diagnostic_procedure - fetoprotein Diagnostic_procedure level was 2.4 Lab_value ng/mL Lab_value (normal <5 ng/mL), total Diagnostic_procedure immunoglobulin Diagnostic_procedure (Ig) Diagnostic_procedure G Diagnostic_procedure was 1880 Lab_value mg/dL Lab_value (normal <640 mg/dL), carbohydrate Diagnostic_procedure antigen Diagnostic_procedure 19 Diagnostic_procedure - 9 Diagnostic_procedure was 856 Lab_value U/mL Lab_value (normal <33 U/mL) and IgG4 Diagnostic_procedure was 890 Lab_value g/L Lab_value (normal <3 g/L).
Doppler Detailed_description ultrasound Diagnostic_procedure , magnetic Diagnostic_procedure resonance Diagnostic_procedure cholangiopancreatography Diagnostic_procedure and magnetic Diagnostic_procedure resonance Diagnostic_procedure imaging Diagnostic_procedure of the liver Biological_structure were suspicious for a subtly Detailed_description enhancing Detailed_description mass Sign_symptom ( 2.8 Distance cm Distance to Distance 4.2 Distance cm Distance in diameter) in the region of the hilum Biological_structure and porta Biological_structure hepatis Biological_structure , obstructing Sign_symptom both the right Biological_structure and Biological_structure left Biological_structure hepatic Biological_structure ducts Biological_structure .
Endoscopic Detailed_description retrograde Detailed_description cholangiopancreatography Diagnostic_procedure identified strictures Sign_symptom in the central Biological_structure portions Biological_structure of Biological_structure the Biological_structure right Biological_structure and Biological_structure left Biological_structure hepatic Biological_structure duct Biological_structure , which was concerning for cholangiocarcinoma Disease_disorder (Figure 1).
Biliary Diagnostic_procedure brushings Diagnostic_procedure were negative Lab_value for Lab_value malignancy Lab_value .
Esophagogastroduodenoscopy Diagnostic_procedure was normal Lab_value .
Biopsies Diagnostic_procedure of the ampulla Biological_structure of Biological_structure Vater Biological_structure revealed chronic Detailed_description active Detailed_description duodenitis Disease_disorder (Figures 2 and ​and3);3); an ancillary Diagnostic_procedure test Diagnostic_procedure confirmed Lab_value the Lab_value diagnosis Lab_value (Figure 4).
Treatment with corticosteroids Medication normalized the patient’s biochemical Detailed_description and radiological Detailed_description abnormalities Disease_disorder within Date three Date months Date .