Abstract
Cholangiocarcinoma is a rare, primary cancer of the biliary tree that can be difficult to diagnose with all imaging modalities. The presenting clinical symptoms of nausea, vomiting, and jaundice can be consistent with classic cholecystitis symptoms, increasing the risk of a missed diagnosis. The most often seen risk factor for cholangiocarcinoma is primary sclerosing cholangitis (PSC). In most cases, the initial diagnostic finding is intrahepatic ductal dilatation. Once an actual mass is seen, liver transplantation is the necessary treatment plan because of likely hepatic metastasis. There is a slight recurrence rate of cholangiocarcinoma even in a transplanted liver. A high percentage of cases are treated with only palliative care. This case presents a classic example of cholangiocarcinoma at the porta hepatis, involving a hyperechoic mass in a dilated common bile duct with abnormalities of the intrahepatic bile ducts and gallbladder.