The imaging features are highly suggestive of a hilar cholangiocarcinoma (a.k.a. Klatskin tumor) involving the confluence of the hepatic ducts and common hepatic duct and extending to the bifurcation of the right hepatic duct, in keeping with a Bismuth-Corlette classification type 3A. 

Endoscopic brushings were sent to cytology: 

Microscopy: The smears consist predominantly of sheets of benign columnar epithelium with scant irregular clustered foci cells showing an enlarged nucleus, nuclear irregularities, irregular hyperchromasia and high nuclear to cytoplasmic ratio with ill-defined gland formation. The findings are in keeping with adenocarcinoma.

Pathologist opinion: Bile duct brushings–malignant.

The lung changes with bronchiectasis and inflammatory nodules were further worked up with CT chest and PET (not shown), involving predominantly the lower lobes, with no convincing metastatic disease identified.