Pathology: bile duct proliferation

This is a nice example of ductular proliferation. Several large profiles are seen around the periphery, and many smaller ones at 11 o’clock. Bile duct proliferation hints at the diagnosis of ductal obstruction (stone, sludge, cancer, stenosis). Oftentimes you will see a neutrophilic infiltrate in the portal region if cholangitis is present. In the right clinical context, a finding like this should prompt an evaluation that can start with ultrasound (to look for dilated ducts). A fuller picture of the biliary tree can otherwise be obtained on MRCP. If an obstructing lesion is present, ERCP should be performed, and if there is a contraindication to ERCP, percutaneous drainage is indicated.

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