Intraductal migration of necrotic hepatocellular carcinoma: A possible cause of obstructive cholangitis after chemoembolization

Abstract

Acute obstructive cholangitis due to the migration of necrotized tumor fragment(s) has been rarely reported after transarterial chemoembolization (TACE). We report an unusual case of it, which was demonstrated by computed tomography (CT) and endoscopic retrograde cholangiography. We suggest that in the setting of acute biliary obstruction after TACE with a CT-demonstrated new intraductal soft tissue lesion with or without a radiopaque portion, along with no or less visualization of a previous tumor located inside or near the duct, the possibility of intraductal migration of a necrotic tumor fragment should be considered. Both clinicians and radiologists should become familiar with this condition because it may be ignored or misinterpreted as biliary calculi.