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Hepatic Pulsations in a Patient With Cholangiocarcinoma

Mark A. Marinella, MD; Albert Klemptner, MD
Arch Intern Med. 1997;157(1):133-135. doi:10.1001/archinte.1997.00440220139022.
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The presence of a pulsatile liver on physical examination usually signifies severe tricuspid regurgitation or constrictive pericarditis but is not cited as a finding of neoplastic involvement of the liver.1,2 We report the interesting physical examination findings of visible and palpable hepatic pulsations in a man with extensive parenchymal involvement of the liver due to cholangiocarcinoma.

Report of a Case.  A 72-year-old man diagnosed as having cholangiocarcinoma 1 year previously was admitted to the University of Michigan Medical Center, Ann Arbor, for stenting of the common bile duct. He initially presented with painless jaundice and underwent attempted resection but soon developed multiple hepatic metastases. His ensuing clinical course was complicated by several episodes of cholangitis, which required endoscopic stenting of the common bile duct. He had been doing well until 3 days before this current admission, when he developed fevers. An ultrasound study revealed multiple large liver lesions consistent


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