Beyond cholangiocarcinoma: imaging features of mimicking pathologies in the biliary tract

Hala Khasawneh, Ciara O'Brien, Ferenc Czeyda-Pommersheim, Aliya Qayyum, Frank H Miller, Hina Arif Tiwari, Raj Mohan Paspulati, Andrea S Kierans

Abdom Radiol (NY). 2025 Jul;50(7):2928-2943. doi: 10.1007/s00261-024-04749-z. Epub 2024 Dec 23.
Abstract
Cholangiocarcinoma (CCA) is the second most common primary malignancy of the hepatobiliary system and presents as a heterogeneous disease with three distinct morphological subtypes: mass-forming, periductal-infiltrating, and intraductal-growing, each characterized by distinguishing imaging features. Accurate diagnosis of CCA is challenging due to the overlap of imaging findings with a broad range of benign and malignant conditions. Therefore, it is essential for radiologists to recognize these mimickers and offer a reasonable differential diagnosis, as this has a significant impact on patient management. Although histopathological confirmation is often required for a definitive diagnosis, understanding specific imaging characteristics that differentiate CCA from its mimickers is crucial. This article highlights a variety of benign and malignant conditions that resemble CCA on imaging, emphasizing features that enhance diagnostic accuracy in clinical practice.