The ultrasonographic appearances of hilar cholangiocarcinoma (Klatskin tumours).

The findings on ultrasound of 40 patients presenting between 1984 and 1987 who were subsequently proven pathologically to have hilar cholangiocarcinoma were reviewed. The sonograms of 17 other patients in whom pathological confirmation was not obtained but who were also presumed to have Klatskin tumours on clinical and radiological grounds, were also reviewed. All patients demonstrated intrahepatic bile duct dilatation with no evidence of free communication between the right and left hepatic ducts. A hilar mass was observed in 74% of the patients. Seventy-nine per cent of the hilar masses were of increased echogenicity relative to surrounding liver, 19% were of reduced echogenicity and 2% of mixed echogenicity. An intraluminal mass was seen in 21% of the patients and bile duct wall thickening was observed in 4%. The mass detection rate of different ultrasound equipment was also compared. In 15 patients the ability of ultrasound to predict the order of intrahepatic bile duct involvement was compared with cholangiography.