Two small intrahepatic cholangiocarcinomas with different sonographic appearances

We report on 2 cases of small intrahepatic (or peripheral) cholangiocarcinomas initially detected by sonography and completely resected. The lesions had a peripheral hypoechoic component and a central isoechoic or hyperechoic component. One had posterior acoustic shadowing on sonography, and the other did not. Comparison with pathologic findings in both cases indicated that severe fibrotic changes may have caused the posterior acoustic shadowing. This finding is extremely rare. We found only 1 previously reported case of cholangiocarcinoma accompanied by acoustic shadowing.