Case 20:   Cholangiocarcinoma

Diagnostic Category:

Clinical Presentation:

57 year old man with jaundice.

CT: Klatskin tumor

Imaging Findings:

CT shows a small, ill defined mass at the confluence of right and left hepatic ducts, demonstrating delayed contrast enhancement typical for fibrotic components (desmoplastic stroma reaction). This results in bilateral moderate obstructive biliary dilatation. Biopsy of the mass was consistent with moderately differentiated cholangiocarcinoma.

Unenhanced image demonstrates suspicious isodense lesion at the biliary confluence (arrow head).

Arterial image demonstrates mild enhancement of biliary confluence lesion( arrow head). Note THAD in the left lobe due to compression of the left portal vein by the mass.

Portal venous demonstrates relative hypodensity of the lesion compared to remainder of the liver parenchyma (arrow head).

Equilibrium image demonstrates progressive delayed enhancement of the lesion compared to adjacent liver parenchyma and appears more conspicuous, very typical of cholangiocarcinoma (arrow head)

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