Presentation
Abdominal pain.
Patient Data
Focal waist-like thickening of the common hepatic duct just beyond the bifurcation of the right and left hepatic ducts, resulting in biliary obstruction and severe biliary ductal dilation. There is a relatively subtle, masslike area of hypoenhancement in hepatic segment 5 marginating the gallbladder fossa. No other masses in the liver. Porta hepatis adenopathy.
Case Discussion
Klatskin cholangiocarcinoma with focal waist like thickening of the common hepatic duct, resulting in severe biliary obstruction. There is a component of the tumor extending into the hepatic parenchyma in hepatic segment 5. There is also suspicious porta hepatis adenopathy.
The next step in management is endoscopy with stenting and brushing/biopsy, which was performed in this case and confirmed the diagnosis.