57 yo F presents with abdominal pain. Total bilirubin >6, Alkaline phosphatase >600. Routine CT obtained, shows biliary obstruction with nodule at the site of obstruction, possible stone or mass.
On spctral analysis, there is iodine uptake in the nodule obstructing the common bile duct, consistent with vascular tissue and excluding stone. Subsequent endoscopic ultrasound confirmed a pancreatic mass, and biopsy showed a pancreatic adenocarcinoma.