Klatskin tumour

Case contributed by Dr Andrei Tsoriev

Presentation

Non painful jaundice 10 days from onset. No other symptoms present.

Patient Data

Age: 60 years
Gender: Male

Multiparametric MRI of the abdomen

Modality: MRI

There is a mass in the hilar region of the liver, with occlusion of common hepatic bile duct, with upstream dilatation of all intrahepatic bil ducts. At the delayed contrast enhanced MRI there is enhancement of tumor, which was unenhanced at arterial and venous phases, which is typical for cholangiocarcinoma. 

Modality: Annotated image

Low intensity at T1-weighted and T2-weighted tumor, with restricted diffusion, enhancing at delayed images.

Case Discussion

Insidious development of jaundice is considered typical for malignant biliary obstruction. This man developed nonpainful jaundice, which raised suspicion for biliary duct or pancreatic tumor, ultrasound showed intrahepatic biliary ducts dilatation and MRCP was performed to access the cause of the such.

MRCP is the main imaging modality to access the cause of biliary tree stenosis/occlusion since it allows to establish the diagnosis in most cases without any intervention. Combining MRCP sequences with ordinary T2-weitheted and T1-weighted sequences, especially with contrast enhancement allows for reliable detection of cholangiocarcinoma which in typical cases demonstrates hilar mass with contrast uptake on delayed, mostly 10-15 minutes from administration, images.

Using MRCP permits establishing further treatment, should it be interventional for temporarily bile hypertension relief or surgery, which is performed on stable and otherwise healthy patients. 

Hilar cholangiocarcinoma, also known as a Klatskin tumor, can be classified according to the Bismuth-Corlette classification. This case is a Bismuth-Corlette type VI, affecting the common hepatic duct with involvement of the confluence and lobar ducts.

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Case Information

rID: 33748
Case created: 22nd Jan 2015
Last edited: 2nd Mar 2017
Inclusion in quiz mode: Included

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