CHOLANGIOCARCINOMA AT THE HEPATIC HILUS - SONOGRAPHIC FINDINGS

OBJECTIVE. This study was performed to characterize sonographic findin gs in patients with cholangiocarcinoma at the hepatic hilus and to com pare those sonographic findings with surgical and pathologic findings. MATERIALS AND METHODS. Thirty-nine consecutive patients with hilar ch olangiocarcinoma (Klatskin turner) had preoperative color and spectral Doppler sonography and had surgical-pathologic correlation, Biliary d rainage catheters were present in 24 patients (62%). In all patients, we evaluated presence of bile duct mass, level of bile duct involvemen t, patency of portal veins, and hepatic mass lesions. RESULTS. Ductal masses were revealed by sonography in 34 patients (87%). Masses were i soechoic in 22 patients (65%), hypoechoic in seven (21%), and hyperech oic in five (15%). The masses included nodular mural thickening in 19 patients (56%), infiltrative lesions in nine (26%), and intraductal po lypoid masses in six (18%). The extent of bile duct involvement was re vealed sonographically in 34 cases (87%) by the distribution of bile d uct obstruction, the location of a ductal mass, or both. Portal vein i nvolvement by tumor was shown sonographically in 20 patients (51%); 13 patients had occluded portal veins, and seven had encased portal vein s without occlusion. Twenty-one portal veins in 16 patients were found to be involved at surgery; sonography showed 18 (86%) of 21 involved portal veins. Hepatic masses were present at surgery in six patients; four of these masses were malignant and two were benign. Sonography re vealed five of the six masses and failed to reveal metastases in one p atient who had pneumobilia from a biliary drainage catheter. CONCLUSIO N. Although Klatskin turners are usually isoechoic, they can be reveal ed by sonography, and their morphology can be characterized. The exten t of bile duct involvement may be shown on sonograms by the location o f tumor and the distribution of bile duct obstruction. Portal vein inv olvement is frequent, and hepatic metastases are uncommon.