A RUQ ultrasound has been ordered on a 63 year old male for abdominal pain and a palpable epigastric lesion felt on clinical exam. The patient states that he has had weight loss but he has being trying to lose a few pounds. As you are scanning the liver, you document an enlarged CBD. You following the CBD and acquire the image above. What is the most likely diagnosis?

Explanation: An enlarged CBD could mean alot of things for a patient of this age. What we need to consider in this case is the age and symptoms the patient exhibits. Weight loss and the abdominal pain are key here. Considering and enlarged CBD which is central to Bile which burns fat in our bodies, we need to run tests to see why the blockage which causes the duct to enlarge is present in the patients body. Check for inflamation and possibly carry out a biopsy of the liquid in the duct. Of course, Cancer is the big one here, but it could also be several factors, like Hepatitis, Gall stones and inflamation due to the blockage in the duct which means the liver is at risk.