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Case of the Month

May 2007

Patient Data: 68 year old female

Clinical Info: Jaundice without pain

Transverse image of the upper abdomen with an intraductal structure in the bile ducts at the liver hilum

Transverse image of the liver with dilatated intrahepatic bile ducts

There is a soft tissue structure at the bifurcation of the bile ducts

The structure shows vascularity which rules out sludge or hemobilia

The gallbladder is small and contracted indicating a high biliary tract obstruction

There are enlarged mesenteric lymphe nodes

CT scan of the same patient showing dilatated intrahepatic bile ducts. The patient was suspected of having a bile duct carcinoma, in this location also known as Klatskin tumor. The prognosis is poor. The enlarged lymphe nodes are suggestive for metastases. An ERCP was performed.

The ERCP shows dilatated intrahepatic bile ducts and a non dilatated distal common bile duct

A brush was performed for pathological confirmation.
To releave the jaundice stents were placed in the bile ducts.
Diagnosis Klatskin tumor (cholangiocarcinoma).

For more cases see

Bloom CM, Langer B, Wilson SR. Role of US in the detection, characterization, and staging of cholangiocarcinoma.
Radiographics. 1999 Sep-Oct;19(5):1199-218.

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