Wassem Juakiem

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A 70-year-old man presented to his primary care physician with progressive shortness of breath. A subsequent workup revealed a normal chest radiograph, but the CT scan of the chest revealed heterogeneous hepatic cysts. Cross-sectional abdominal imaging revealed “beaded” bilobar intrahepatic biliary ductal dilation and narrowing of the distal common bile duct concerning for obstruction ( Fig. 1 ). Laboratory analysis showed normal liver function tests. He reported 15 years of heavy alcohol use.