A 55-year-old woman presents with right upper quadrant pain and jaundice. MRCP shows a stricture at the biliary confluence with proximal intrahepatic biliary dilatation isolated to the right lobe; the left intrahepatic ducts are also dilated but do not communicate with the right system. The common bile duct and gallbladder are normal. Which Bismuth-Corlette classification does this represent?
- A Type IIIA
- B Type IV ✓
- C Type II
- D Type I
Correct answer: B. Type IV
Explanation
The Bismuth-Corlette classification describes hilar cholangiocarcinoma extent. Type I involves the common hepatic duct below the confluence. Type II involves the confluence itself. Type IIIA involves the right secondary radicals; IIIB the left. Type IV involves both right and left secondary intrahepatic radicals or multiple intrahepatic strictures. The described scenario shows involvement of the confluence with disconnection of the right and left systems extending into both lobar ducts, which is Type IV. This classification guides surgical resectability.
Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.
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