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A 40-year-old woman presented with complaints of pain in the right hypochondrium and intermittent high-grade fever with chills for 3 months. She had a history of waxing and waning jaundice for the last 2 months. She had undergone open cholecystectomy 15 years back. Abdominal examination revealed a non-tender hepatomegaly. Blood investigations showed a deranged liver function suggestive of obstructive biliary pathology. Total bilirubin level was raised (4.6 mg/dL) with predominant direct component (3.5 mg/dL). Her serum alkaline phosphatase was elevated (1683 U/L) but transaminase levels were within normal range.
An abdominal ultrasound showed mild hepatomegaly with bilateral intrahepatic biliary radicle dilation. Multiple calculi were present in the intrahepatic bile ducts and a hypoechoic shadow was seen near hilum. In view of suspected mass lesion at hilum, an abdominal CT …
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