62-year-old female. Cholangiocarcinoma, hyperbilirubinemia. Evaluate obstruction of biliary tree. ABDOMEN:LIVER, BILIARY TRACT: Infiltrative soft tissue at Klatskin's point and in the distribution of the central left and right biliary ducts to the tertiary level consistent with infiltrative cholangiocarcinoma. Mild associated upstream intrahepatic biliary ductal dilatation in the periphery of the liver, greater in the left lobe. There is eccentric narrowing of the CBD due to tumor infiltration from Klatskin's point down to the mid CBD, where it is most severely attenuated (series 701, image 97). The intrapancreatic segment of the CBD is normal in caliber and appears unaffected by tumor.Loss of normal flow voids in the intrahepatic and extrahepatic portal vein as well as right and left branches, replaced with intermediate T2 signal intensity consistent with extensive tumor thrombus.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Confluent lymphadenopathy in the portal hepatis and inferior to the liver, likely local metastases. For reference, there is a node that measures 1.6 x 1.1 cm (series 601, image 307). BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Large amount of abdominal ascites, suspicious for malignant ascites. OTHER: No significant abnormality noted.
1. Infiltrative cholangiocarcinoma at Klatskin's point and completely obstructing the central left and right intrahepatic ducts to the tertiary level. Inferior extension of tumor down to the mid-CBD, which is severely attenuated.2. Extensive tumor thrombus in the entire main portal vein and its branches.3. Large amount of abdominal ascites, suspected to be malignant, and local metastatic lymphadenopathy.