简介：AIM:Tostudythediagnosisofhepatocellularcarcinoma(HCC)presentingasbileducttumorthrombuswithnodetectableintrahepaticmass.METHODS:SixpatientswithpathologicallyprovenbileductHCCthrombibutnointrahepaticmassdemonstratedonthepreoperativeimagingorpalpatedintrahepaticmassduringoperativeexploration,werecollected.Theirclinicalandimagingdatawereretrospectivelyanalyzed.Themajorfindingsorsignsoncomprehensiveimagingwerecorrelatedwiththesurgicalandpathologicfindings.RESULTS:Jaundicewasthemajorclinicalsymptomofthepatients.Theelevatedserumtotalbilirubin,directbilirubinandalanineaminotransferaselevelswereinconcordancewithobstructivejaundiceandtheunderlyingliverdisease.Ofthe6patientsshowingevidenceofviralhepatitis,5werepositiveforserumalphafetoproteinandcarbohydrateantigen19-9,and1waspositiveforserumcarcinoembryonicantigen.Nopatientwascorrectlydiagnosedbyultrasound.Themainfeaturesofpatientsoncomprehensiveimagingwerefillingdefectswithcup-shapedendsofthebileduct,withlargefillingdefectspresentingascastingmouldsintheexpandedbileduct,hypervascularintraluminalnodules,debrisorbloodclotsinthebileduct.Noobviouscircularthickeningofthebileductwallswasobserved.CONCLUSION:Evenwithnodetectableintrahepatictumor,bileductHCCthrombusshouldbeconsideredinpatientspredisposedtoHCC,andsomeimagingsignsareindicativeofitsdiagnosis.