Presentation
Jaundice, presence of coluria, generalized itching, subsequently accompanied by a weight loss of approximately 18 kg in 6 months, as well as postprandial epigastric pain.
Patient Data
The liver without alterations.
The gallbladder is of the usual size and shape, without stones inside.
Intrahepatic bile duct dilatation of the right bile duct of the second order of 8 m and third order of 7 mm. Common bile duct at the hilar level of 6.4 mm. Common bile duct in its supraduodenal portion of 7mm, intraduodenal of 6mm, without identifying the site of obstruction.
Percutaneous biliary drain with the tip in the common bile duct.
Atherosclerotic plaques in isolation at the level of the abdominal aorta. Umbilical hernial defect of 7.3 mm of fat content.
The right hepatic bile duct proximal to the common hepatic duct has a diameter of 11 mm, with hypointense material inside to be considered bile sludge.
The left hepatic bile duct proximal to the common hepatic duct has a diameter of 6 mm, with hypointense material inside to be considered biliary sludge.
At the confluence level of the hepatic ducts, predominantly right, an image of irregular morphology, partially defined borders, slightly hypointense on T1, hyperintense on T2, and heterogeneous enhancement predominantly peripheral to the application of paramagnetic contrast medium is observed. Said lesion measures 26 x 18 mm in its maximum axes in the axial plane, which leads to partial obliteration of the common hepatic duct as well as an area of stenosis that extends caudally with a length of 28 mm and periductal enhancement adjacent to the biliary confluence.
Additionally, the presence of perihepatic and perisplenic free fluid is commented on.
Case Discussion
Klatskin tumors are a cholangiocarcinoma that occurs at the intersection of the right and left lobes of hepatic bile ducts forming the common bile duct.
The most important risk factor is primary sclerosing cholangitis.
The Bismuth-Corlette classification is used to see the topographic involvement of the bile ducts from their extension, being in this case IIIa because the tumor involves the right hepatic duct.
Being the same aggressive and asymptomatic until it is diagnosed in advanced stages. The only treatment is surgery in which not all patients are candidates and will depend on vascular, lymph node invasion, or metastasis.
Unable to process the form. Check for errors and try again.