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Case of the Month

May 2011

Patient Data: 42 year old male

Clinical Info: Jaundice

Transverse image of an empty gallbladder and abnormal structures around and next to the gallbladder

Longitudinal image of the empty gallbladder and abnormal structures.

Detail image of the structures next to the gallbladder showing tortuous veins

Color doppler image showing flow in the tortuous veins

Transverse image of the left liver lobe showing dilatated intrahepatic bile ducts.

Another image of the left liver lobe showing dilatated intrahepatic bile ducts.

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

Detail of the mass with invasion and compression of the bile ducts and portal vein

Image of the liver hilum showing the obstruction of the portal vein and collateral veins in the gallbladder region

Detail image of the liver hilum showing tumor in the portal veins

Detail image of the bile ducts with tumor masses

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

The pancreas of the patient was normal, but there were also collateral veins around the pancreas

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.

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