58 year-old male. History of cholangiocarcinoma. Evaluate for biliary obstruction. Elevated bilirubin, fever. Lack of intravenous contrast limits evaluation of solid organ pathology as well as of the vasculature.ABDOMEN:LIVER, BILIARY TRACT: Infiltrative tumor at Klatskin's point causes obstruction of the bilobar intrahepatic ducts, which are markedly dilated, left lobe greater than right. Two common duct stents drain the central left and right biliary ducts. Cholelithiasis. Patency of the hepatic vasculature cannot be determined without intravenous contrast.SPLEEN: Mild splenomegaly measuring 14 cm in length.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal cyst.RETROPERITONEUM, LYMPH NODES: Confluent periportal and retroperitoneal lymphadenopathy. Reference aortocaval lymph node is 4 x 2.8 cm (series 601, image 8), unchanged. Diffuse restricting nodularity anterior to the liver and in the midline anterior abdomen (series 800, image 401 and 343) concerning for peritoneal carcinomatosis, new from prior.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
Infiltrative cholangiocarcinoma at Klatskin's point causes marked bilobar intrahepatic biliary ductal dilatation, greater in the left hepatic lobe. Findings concerning for peritoneal carcinomatosis, new from prior.