Clinical Presentation

A 55-year-old man presents with jaundice.

(A) Contrast-enhanced computed tomography (CT) in the arterial phase shows a prominent common bile duct (CBD; arrowhead). (B,C) Adjacent images show early enhancement of an enlarged papilla (arrows), which measures 2 cm in diameter.

Differential Diagnosis

• Ampullary carcinoma: This is the most likely diagnosis, given the papillary enlargement and early enhancement.

• Cholangiocarcinoma: This is a consideration as it may have identical features.

• Duodenal tumors: An adenoma or adenocarcinoma may be periampullary in location.