This 79 year old lady presented with a 5 day history of nausea and vomiting. She was noted to be jaundiced.
Liver function tests revealed an obstructive pattern
An epigastric mass is evident in the region of the head of pancreas. There is evidence of both intrahepatic and common bile duct dilatation. The distal CBD is dilated to 17mm
The presence of intrahepatic duct dilatation together with dilatation of the distal CBD suggests a distal obstucting lesion. Further investigation with CT revealed an extensive tumour involving the head of pancreas. Biopsy of a lesion in the liver confirmed a diagnosis of adenocarcinoma from a presumed pancreatic carcinoma. ERCP confirmed a distal CBD stricture and a stent was placed