Intrahepatic Cholangiocarcinoma in a Cirrhotic Patient without Upstream Biliary Dilatation

Intrahepatic cholangiocarcinoma (IHC) is a biliary tumor that arises from the intrahepatic bile ducts. It is the second most common primary hepatic malignancy after hepatocellular carcinoma (HCC), with higher prevalence in patients with cirrhosis and Hepatitis B and C. On imaging, IHC typically demonstrates progressive centripetal progression and significant delayed enhancement with dilatation of the bile ducts upstream from the tumor. We report a case of IHC in a cirrhotic patient which exhibited delayed enhancement but no evidence of upstream ductal dilatation. Due to differences between IHC and HCC in prognosis and treatment options, IHC should be considered in a cirrhotic patient when the hepatic tumor demonstrates delayed centripetal enhancement on CT and/or MR, even in the absence of upstream biliary dilatation.