Choledocholithiasis at the hepatic confluence mimicking a hilar cholangiocarcinoma

Adenocarcinomas of the bifurcation of the hepatic ducts (Klatskin tumors) a re a relatively rare cause of obstructive jaundice. Differential diagnosis includes other neoplastic lesions, sclerosing cholangitis, Mirizzi's syndro me and benign strictures. We present a 46 year-old white female with a 2 mo nth history of epigastric pain and progressive jaundice. Endoscopic retrogr ade cholangiopancreaticography (ERCP) revealed a filiform stenosis of the r ight hepatic duct and an obstructed left hepatic duct, an image strongly su ggestive of a Klatskin tumor. The correct diagnosis was achieved, however, by percutaneous transhepatic cholangiography (PTC), which disclosed a galls tone at the common hepatic duct bifurcation and multiple small concrements in the left hepatic duct. After endoscopic removal of the gallstones in the biliary tree and laparoscopic cholecystectomy, the patient was discharged on the third post-operative day. Protuberant tumors and round biliary stone s may be confused at ERCP.