Case of August 2012

Clinical History:

This 53-year-old lady, with unremarkable past health, presented with bouts of epigastric pain and tea-coloured urine. Endoscopic retrograde cholangiopancreatography (ERCP) revealed dilated intrahepatic ducts and a stricture in the lower common bile duct (CBD) which prompted stent placement (blue arrow in the first image) and a brush cytology which came back negative. Abdominal CT performed at presentation and 6 months later showed essentially static features (images from the later set of CT is shown). Meanwhile, this lady was also seen by ophthalmologists for painless proptosis of a few years' duration.