Dotted Fried Egg Pan Appearance: A Sign of Aggressive Intrahepatic Mass Forming Cholangiocarcinoma

Background: Intrahepatic Cholangiocarcinomas (ICC) are the second most common primary malignant liver tumors after Hepatocellular carcinomas (HCC). They pose a diagnostic challenge, and often it becomes difficult to distinguish these from metastases, particularly adenocarcinomas from the gut, pancreas, and gall bladder. In some patients, atypical presentations on imaging also make it difficult to distinguish them from HCC lesions. Case presentation: Authors present one such case of a 60-year female with history of nausea with weight loss of recent onset for ultrasound examination which revealed multiple hypoechoic nodules in the liver. A CECT and Plain MRI examination confirmed the same. A triple phase CE MRI was done which revealed a large heterogenous liver mass with satellite nodules in the remaining liver with a dotted fried egg pan appearance”. A guided Fine needle aspiration and biopsy was done which showed adenocarcinoma metastasis. Conclusions: Authors describe a new sign not described earlier “Dotted fried egg pan sign” which is a sine qua non of an aggressive mass forming ICC and differentiates it from other mimicking lesions of the liver.