A 55-year-old female presents with persistent deep right upper quadrant pain, low-grade fever, and progressive jaundice. Total bilirubin is 12 mg/dL. Abdominal ultrasound shows marked intrahepatic biliary duct dilation, a collapsed gallbladder, and a non-dilated common bile duct. Cross-sectional imaging reveals a mass at the confluence of the right and left hepatic ducts. What is the diagnosis?

Answer and explanation

Correct answer: C. Klatskin tumor (Hilar cholangiocarcinoma)

  1. Step 1: A cholangiocarcinoma arising at the junction (confluence) of the right and left hepatic ducts is known as a Klatskin tumor (hilar cholangiocarcinoma).
  2. Step 2: Because the obstruction occurs proximal to the cystic duct, it characteristically produces painless jaundice, marked intrahepatic duct dilation, and a collapsed, empty gallbladder.
  3. Step 3: Identify Klatskin tumor.
Answer
Klatskin tumor (Hilar cholangiocarcinoma).
Why not the others: 'Choledocholithiasis' typically produces a dilated common bile duct with acoustic shadowing stones; 'Ampullary carcinoma' and 'Pancreatic head adenocarcinoma' obstruct the distal common bile duct, causing both extrahepatic/intrahepatic dilation and a palpably enlarged gallbladder (Courvoisier's law).

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