Presentation
Progressive obstructive jaundice and extrahepatic cholestasis. No pain or other associated symptoms.
Patient Data
Marked diffuse intrahepatic bile duct dilatation upstream of an ill-defined stricture involving the confluence of the right and left hepatic ducts, measuring up to 18 mm on axial images.
The dilatation involves predominantly the left lobe (segments 2 and 3)
Exclusion of the left and right hepatic ducts.
Complete thrombosis of the distal part of the left portal vein, with subsequent atrophy of the left lobe.
There is a hypodense lesion in segment V, that needs further assessment by MRI.
There is no lymphadenopathy.
Marked diffuse intrahepatic bile duct dilatation upstream of an ill-defined lesion involving the confluence of the right and left hepatic ducts.
The hypodense lesion of segment V corresponds to a simple hepatic cyst.
There is no dilatation of the common bile duct.
Exclusion of the left and right hepatic ducts with the probable exclusion of segment 7.
The pancreas is unremarkable.
There is no lymphadenopathy.
Case Discussion
Features of a perihilar cholangiocarcinoma, also known as Klatskin tumor. It may be challenging to visualize the mass, as it is usually ill-defined and most of the imaging features are indirect signs of tumor development such as biliary duct dilatation, vascular involvement, or regional lymphadenopathy.
In this case, the tumor probably arises from the left hepatic duct (left portal vein invasion, lobe atrophy and marked ipsilateral intrahepatic ducts dilatation) with a later invasion of the right hepatic bile duct.