Differential Diagnosis
- Single most likely diagnosis
- Peri-ampullary cancer (e.g., ampullary carcinoma, pancreatic cancer): The patient's history of abdominal pain, vomiting, and significant dilatation of the CBD and pancreatic duct, along with suspected duodenal wall thickening at the peri-ampullary region on MRCP, strongly suggests a peri-ampullary mass. The patient's age and history of malignancy (lymphoma and previous hysterectomy for malignancy) also increase the likelihood of this diagnosis.
- Other Likely diagnoses
- Choledocholithiasis: Although the patient had a cholecystectomy 10 years ago, it's still possible for gallstones to form in the bile ducts, causing obstruction and dilatation. The patient's symptoms of abdominal pain and vomiting, along with the dilated CBD, could be consistent with this diagnosis.
- Biliary stricture: The patient's history of radiotherapy and previous malignancies could increase the risk of developing a biliary stricture, which could cause obstructive jaundice and dilatation of the bile ducts.
- Pancreatic cancer: The dilatation of the pancreatic duct and the suspected duodenal wall thickening could also be consistent with pancreatic cancer.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Bile duct perforation: Although less likely, a bile duct perforation could be a life-threatening condition that requires immediate attention. The patient's symptoms of abdominal pain and vomiting could be consistent with this diagnosis.
- Sphincter of Oddi dysfunction: This condition could cause obstructive jaundice and abdominal pain, and although less likely, it's essential to consider it in the differential diagnosis.
- Rare diagnoses
- Biliary cast syndrome: This rare condition is characterized by the formation of a cast within the bile ducts, causing obstruction and dilatation. Although unlikely, it's essential to consider it in the differential diagnosis, especially given the patient's complex medical history.
- Primary sclerosing cholangitis: This rare autoimmune disorder could cause inflammation and fibrosis of the bile ducts, leading to obstructive jaundice and dilatation. Although unlikely, it's essential to consider it in the differential diagnosis, especially given the patient's history of autoimmune disorders (e.g., atrial fibrillation).