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Case of the Month

May 2011

Patient Data: 42 year old male

Clinical Info: Jaundice


37314-Afbeelding1.jpg
Transverse image of an empty gallbladder and abnormal structures around and next to the gallbladder


37315-Afbeelding2.jpg
Longitudinal image of the empty gallbladder and abnormal structures.


37316-Afbeelding3.jpg
Detail image of the structures next to the gallbladder showing tortuous veins


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Color doppler image showing flow in the tortuous veins


37318-Afbeelding5.jpg
Transverse image of the left liver lobe showing dilatated intrahepatic bile ducts.


37319-Afbeelding6.jpg
Another image of the left liver lobe showing dilatated intrahepatic bile ducts.


37320-Afbeelding7.jpg
The intrahepatic bile ducts of the right liver lobe are not so dilatated, but there is a mass lesion in the liver hilum


37321-Afbeelding8.jpg
Detail of the mass with invasion and compression of the bile ducts and portal vein


37322-Afbeelding9.jpg
Image of the liver hilum showing the obstruction of the portal vein and collateral veins in the gallbladder region


37323-Afbeelding10.jpg
Detail image of the liver hilum showing tumor in the portal veins


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Detail image of the bile ducts with tumor masses


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The hepatic artery is open and shows high peak systolic velocities of more than 2 mtrs. /sec. as can be expected in a case of portal vein occlusion


37326-Afbeelding13.jpg
The pancreas of the patient was normal, but there were also collateral veins around the pancreas


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Flow in the collateral veins around the pancreas


37328-Mijn_Film.wmv.SWF Axial CT arterial phase


37329-Mijn_Film.wmv_2.wmv.SWF Axial CT venous phase


37330-Mijn_Film.wmv_3.wmv.SWF Coronal CT venous phase


37331-Mijn_Film.4.wmv.SWF Sagittal CT venous phase

The ultrasound findings are a centrally located tumor mass in the liver with invasion and obstruction of the intrahepatic bile ducts of the left liver lobe. Portal vein thrombosis and collateral veins around the gallbladder and pancreas. Biopsy proved the mass to be a cholangiocarcinoma. A centrally in the liver located cholangiocarcinoma is called a Klatskin tumor

For more examples of Klatskin tumors and tumor thrombus in portal vein see

Copyright © Dr. T.S.A. Geertsma, Ziekenhuis Gelderse Vallei, Ede, The Netherlands. All rights reserved.