Intrahepatic Biliary Ductal Dilatation
A 72-year-old woman presented to the hospital with abdominal pain, jaundice, and pruritus. She reported a 6-kg weight loss over the previous 2 months. Laboratory studies showed a direct bilirubin level of 14.3 mg per deciliter (normal range, 0.1 to 0.3), an alkaline phosphatase level of 223 U per liter, an aspartate aminotransferase level of 55 U per liter, and an alanine aminotransferase level of 56 U per liter. Magnetic resonance imaging of the abdomen revealed marked intrahepatic biliary ductal dilatation, with tapering and cutoff near the hilum (arrow). A hepatic hilar mass with vessel involvement was also visualized (not shown). The imaging was consistent with a diagnosis of hilar cholangiocarcinoma, or Klatskin’s tumor. She underwent percutaneous transhepatic cholangiography with biliary drainage, and a biopsy specimen was obtained from the hilar mass. Histopathological evaluation confirmed the diagnosis of cholangiocarcinoma. Lung metastases were also noted. Given a number of considerations, including involvement of both the hepatic artery and the portal vein, the tumor was not considered to be resectable. In addition to biliary drainage, supportive palliative care was pursued.