Klatskin Tumor2
Klatskin Tumor2
Asmara(406100100)
I. DEFINISI
II. EPIDEMIOLOGI
III. PATOFISIOLOGI
V. RADIOGRAFI DIAGNOSTIK
1. Ultrasonography
Merupakan salah satu first line modality imaging yang dipilih
untuk mengevaluasi cholestasis atau disfungsi hepar. Penemuan
termasuk tanda-tanda tidak spesisifik seperti dilatasi IHBD
dengan perubahan kasar dari kaliber duktus biliaris pada kasus
ekstrahepatik dan hillar cholangiocarcinoma. Doppler USG dapat
membantu dalam mendeteksi kompresi dan pembungkusan
tumor pada vena portal atau arteri hepatikus. Sensitivitas dan
spesifikasi dari USG rendah dalam mendiagnosis
cholangiocarcinoma.
2. Computed Tomography
A case with type IIIb Klatskin tumor. Plain CT scan reveals that the tumor is in
the main trunk of left hepatic duct with dilatation of branches.
3. Cholangiography
Salah satu test yang paling penting dalam mengevaluasi
cholangiocarcinoma. Memungkinkan diagnosa dini dan dapat
Saat ini, MRI dengan MRCP adalah modality imaging terbaik yang
tersedia untuk cholangiocarcinoma. Mengungkapkan lokasi dan
perluasan dari pertumbuhan tumor, memperlihatkan lokasi
obstruksi dan dilatasi IHBD. Menyediakan informasi berhubungan
dengan luas tumor, anatomi biliaris dan parenkim hepar, dan
metastase intrahepatik.
(b) Cholangiogram at the time of ERCP of the same patient demonstrates the
appearance as in MRCP.
Type IIIA hilar cholangiocarcinoma (Klatskin tumor). (A) Coronal Half Fourier
RARE T2-weighted image shows a hypointense infiltrating tissue at the primary
biliary confluence. (B) Coronal Half Fourier RARE MRCP shows a separation of
the primary biliary confluence and also a separation of the right secondary
confluence, also because of low insertion of the posterolateral intrahepatic bile
duct. Primary confluence separation can be better appreciated on the coronal
thin slice (2 mm) Half Fourier RARE MRCP
RARE sequence shows intrahepatic duct dilatation and obstruction at the porta
hepatis (arrow).
Hilar cholangiocarcinoma (Klatskin tumor). (A) Axial Spoiled Gradient Echo T1-weighted
image shows a hypointense lesion in the left lobe, with infiltrating grow pattern. (B) On
Half Fourier RARE T2-weighted image, the lesion appears hypointense to adjacent liver
parenchyma. The lesion infiltrates the intrahepatic bile duct of the left lobe with
upstreamdilation. On dynamic T1-weighted Spoiled Gradient Echo, the lesion appears
hypovascular compared with adjacent liver parenchyma (C), with progressive
enhancement during the portal venous phase (D), reaching a peak during the delayed
phase (E). (F) Delayed contrast enhancement can be better appreciated on coronal fat-
suppressed, Spoiled Gradient Echo T1-weighted images; coronal imaging is also well-
suited to assess portal vein encasement. (G) Coronal thick-slab Half Fourier RARE MRCP
shows a type IIIB infiltration of the bile duct, according to Bismuth.
VI. TERAPI
1. Karsinoma pankreas
Arrows: Note enhancing mass head of pancreas extending medially into the
uncinate process.
2. Kronik pankreatitis
a. NECT
3. Choledocholithiasis