The protean manifestations of metastatic disease involving the biliary tract

Like sclerosing cholangitis and cholangiocarcinoma, metastatic disease may involve any porton of the biliary tract and mimick other biliary diseases. Fifty patients with proved metastatic disease (mainly gastrointestinal in origin) involving the biliary tree were retrospectively studied to look for characteristic cross-sectional and cholangiographic patterns of involvement. Thirty patients had intrashepatic ductal encasement, amputation, or displacement. Eight patients had porta hepatis tumor involvement, while six had distal bile duct abnormalities associated with pancreaticoduodenasl adenopathy. In three patients, the findings were indistinguishable from advanced schlerosing cholangitis. Three additional patients had polypoid masses mimicking intraductal involvement by hepatoma. As biliary metastases produce a broad spectrum of appearances, caution must be used so as not to erroneously suggest secondary diagnoses