Solution to Unknown Case #27 – Klatskin Tumor

History: 65 year old male with jaundice. 

Klatskin Tumor: Axial CT of the abdomen with intravenous contrast reveals an enhancing mass near the gallbladder neck (yellow arrow). This is compatible with a Klatskin tumor (hilar cholangiocarcinoma).

Intrahepatic Biliary Dilatation: Axial CT of the abdomen and pelvis in the same patient at a more superior level reveals significant intrahepatic biliary dilatation (yellow arrows) compatible with bile duct obstruction by the Klatskin tumor seen in the first image above.

This is a Klatskin tumor causing bile duct obstruction and biliary dilatation. A Klatskin tumor is a cholangiocarcinoma that arises at near the confluence of the right and left hepatic ducts and causes obstruction of bile duct outflow, leading to biliary dilatation as seen in the second image above. Other causes of biliary dilatation may include pancreatic carcinoma, choledocholithiasis, chronic pancreatitis, primary sclerosing cholangitis, and others. Read about mimics of cholangiocarcinoma here.

Cholangiocarcinoma is most common in patients older than 60, has a slight male predominance, and is more common in Asia. The five year survival unfortunately is very poor for extrahepatic cholangiocarcinoma, on the order of 1-2%.