Introduction MC maligancy of bile duct Caused by primary sclerosing cholangitis (MCC) thorotrast choledochal cyst Clonorchis sinensis (Chinese liver fluke) May be located intrahepatically at the junction of R/L hepatic ducts at the ampulla Presentation Symptoms jaundice Physical exam palpable gallbladder Courvoisier's sign hepatomegally Evaluation US ERCP