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Case of the Month

May 2007

Patient Data: 68 year old female

Clinical Info: Jaundice without pain


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


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Transverse image of the liver with dilatated intrahepatic bile ducts


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


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The structure shows vascularity which rules out sludge or hemobilia


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


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There are enlarged mesenteric lymphe nodes


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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.


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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).

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References
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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