A 33-year-old female was referred for abdominal pain and abnormal imaging suggestive of possible cholangiocarcinoma. The patient had presented to the ER with RUQ pain associated with nausea and vomiting. She had a cholecystectomy over 11 years ago for choledocolithiasis post-partum with an ERCP and stent placement followed by a laparascopic cholecystectomy, which was uneventful. The patient had two subsequent pregnancies without any complications. However, the patient’s temporary biliary plastic
stent was never removed. She was under the impression that it was removed during cholecystectomy and no further intervention was needed. She reported having chronic intermittent, mild biliary type pain but attributed it to post ccy sequalae, until recently when her pain worsened and increased with abdominal flexion. The patient was seen in the ER, and a CT scan showed the biliary stent with a 2cm low attenuated lesion at the confluence of the right and left intrahepatics with intrahepatic dilation. The biliary stent was just below the lesion. The patient did have recent weight loss which was intentional.