Case contributed by Ian Bickle
Diagnosis certain


Short history of weight loss and anorexia. Clinically jaundiced. Bilirubin 166. GGT 1919. C19-9 4472 U/mL Cause?

Patient Data

Age: 74
Gender: Male


Severe diffuse intrahepatic duct dilatation down to the porta hepatis, with an abrupt cut off with a common hepatic and bile duct of normal caliber.

Approximately 6cm ill defined mass in segment 4a/b extending to the porta, at the site of the aforementioned cut-off.

No synchronous hepatic lesions.

Gallbladder packed with stones.  Normal wall thickness.

The remainder of the solid organs are normal.

No portal nodes.

CT as part of staging study



CBD stent is in situ, extending into right hepatic duct.

Moderate dilatation of intrahepatic biliary ducts in the left hepatic lobe. 

Ill defined mass measuring 4.3 x 5.4 cm in segment 4.

Small volume periportal lymph nodes, measuring upto 8mm.

No significant para-aortic lymphadenopathy. No ascites.

The gallbladder is distended and contains stones.

Spleen, pancreas, both kidneys and adrenals are unremarkable.

Brushings performed at ERCP during the biliary stenting procedure confirmed a cholangiocarcinoma.

Case Discussion

This patient presented with severe jaundice for which an MRCP was performed after ultrasound identified biliary obstruction.

On MRCP the CBD is of normal caliber despite severe intrahepatic duct dilatation, therefore the site of obstruction was at the porta.   The ill defined intrahepatic mass in this context was strongly suggestive for a cholangiocarcinoma (Klatskin tumor), which was subsequently proven on histology.

Cholangiocarcinoma is a highly malignant tumor arising from cholangiocytes in the biliary tree, with a poor prognosis.


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