Figure 1.

Enhanced magnetic resonance imaging of the upper abdomen and echoendoscope in a 59-year-old female patient with obstructive jaundice. (A - C) Partial defect of the right posterior lobe of the liver. Irregular patchy long T1 signal shadows are seen in the operative area and the posterior superior segment of the right lobe of the liver, with poorly defined borders and a maximum cross-sectional extent of 75 mm × 16 mm. The intrahepatic bile duct is slightly dilated. (D, E) A hypoechoic mass is seen in the lumen of the duodenal segment of the choledochus to the common hepatic duct. The echogenicity is not uniform, and the elastography suggests a hard texture."

Figure 2.

ERCP nasocholangiograms in a 59-year-old female patient with obstructive jaundice. (A, B) The first ERCP nasocholangiogram shows no significant dilatation of the intra- and extrahepatic bile ducts. (C) Five days later, the second nasocholangiogram shows a slightly irregular shape of the local bile duct wall in the upper part of the common bile duct, along with a possible filling defect."

Figure 3.

SpyGlass examination and biopsy in a 59-year-old female patient with obstructive jaundice. (A) The lower part of the common bile duct is patent, with smooth mucosa. (B) A long clot in shape of “Buddha’s hand” is seen in the middle and upper parts of the common bile duct. (C) Along the clot, a new organism (arrow) is seen at the opening of right posterior hepatic duct occupying most of the duct lumen, with surface hemorrhage and blood crust attached. A SpyGlass bite biopsy was performed."

Figure 4.

Pathologies of biopsies with the SpyBite during SypGlass examination of a 59-year-old female patient (HE staining, 10X). (A) Multiple piles of suspected cancer cells are seen in the smear. (B) Right hepatic duct biopsy pathology: degenerated necrotic tissue and small granulation tissue were sent for biopsy, within which a few hepatocytes are seen, with enlarged hepatocyte nuclei. Hepatocellular carcinoma tumor thrombus was considered."