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1
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Hando DJ, Kitua DW, Bitesigilwe MD, Mutajwaha JL, Gabolwelwe M, Chande HM, Mwanga AH, Bokhary ZM, Ngiloi PJ. Choledochal cyst type I with dilated intrahepatic biliary radicles: a type IVA mimic. EGYPTIAN LIVER JOURNAL 2022. [DOI: 10.1186/s43066-022-00193-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
A choledochal cyst is a relatively rare congenital anomaly of the biliary tree requiring surgery as the definitive treatment. Amongst the five Todani variants, type I poses a diagnostic and treatment challenge owing to its infrequent, yet clinically significant mimicry for type IVA cysts.
Case presentation
We present a case of a 4-year-old female diagnosed to have a giant type IA choledochal cyst that mimicked a type IVA cyst on radiological imaging. The patient was treated by complete cyst excision, cholecystectomy, and restoration of the biliary-enteric communication by a Roux-en-Y hepaticojejunostomy. Regression of the dilated intrahepatic radicles that counterfeited a type IVA cyst was confirmed on follow-up imaging studies.
Conclusion
Such an encounter, although rare, can significantly alter the course of management. We recommend extrahepatic cyst excision with biliary reconstruction as the standard treatment when preoperative and intraoperative imaging studies fall short in differentiating the aforementioned variants.
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Devane AM, Annam A, Brody L, Gunn AJ, Himes EA, Patel S, Tam AL, Dariushnia SR. Society of Interventional Radiology Quality Improvement Standards for Percutaneous Cholecystostomy and Percutaneous Transhepatic Biliary Interventions. J Vasc Interv Radiol 2020; 31:1849-1856. [PMID: 33011014 DOI: 10.1016/j.jvir.2020.07.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 07/14/2020] [Indexed: 12/13/2022] Open
Affiliation(s)
- A Michael Devane
- Department of Radiology, Prisma Health, University of South Carolina School of Medicine Greenville, Greenville, South Carolina.
| | - Aparna Annam
- Department of Radiology, University of Colorado School of Medicine, Aurora, Colorado; Interventional Radiology, Children's Hospital Colorado, Aurora, Colorado
| | - Lynn Brody
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Andrew J Gunn
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Sheena Patel
- Society of Interventional Radiology, Fairfax, Virginia
| | - Alda L Tam
- Department of Interventional Radiology, MD Anderson Cancer Center, Houston, Texas
| | - Sean R Dariushnia
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
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3
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Koukoura O, Kelesidou V, Delianidou M, Athanasiadis A, Dagklis T. Prenatal sonographic diagnosis of biliary tract malformations. JOURNAL OF CLINICAL ULTRASOUND : JCU 2019; 47:292-297. [PMID: 30729537 DOI: 10.1002/jcu.22705] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 01/10/2019] [Accepted: 01/20/2019] [Indexed: 06/09/2023]
Abstract
Congenital anomalies of the biliary tract include a variety of pathologic conditions, such as biliary atresia, choledochal cysts, gallbladder agenesis, congenital cholelithiasis, and gallbladder duplication. Although most of these malformations are rare and benign conditions, they may occasionally represent a major threat to extrauterine life. Visualization of a normal-sized gallbladder should be a mandatory component of the second-trimester anomaly ultrasound scan. Advances in prenatal sonography enable the detection of biliary tract congenital malformations. In this review, we discuss the detection rates, sonographic features, and prognosis of the most frequently prenatally diagnosed biliary tract malformations.
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Affiliation(s)
- Ourania Koukoura
- Department of Obstetrics and Gynecology, University Hospital of Larissa, Larissa, Thessaly, Greece
| | - Veroniki Kelesidou
- Third Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Marina Delianidou
- Third Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Apostolos Athanasiadis
- Third Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Themistoklis Dagklis
- Third Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloniki, Greece
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De Silva WSL, Pathirana AA, Wijerathne TK, Gamage BD, Dassanayake BK, De Silva MM. Epidemiology and disease characteristics of symptomatic choledocholithiasis in Sri Lanka. Ann Hepatobiliary Pancreat Surg 2019; 23:41-45. [PMID: 30863806 PMCID: PMC6405359 DOI: 10.14701/ahbps.2019.23.1.41] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 10/05/2018] [Accepted: 10/07/2018] [Indexed: 12/22/2022] Open
Abstract
Backgrounds/Aims Published data on choledocholithiasis in Sri Lanka is scarce. This study was conducted to determine epidemiological, clinical and endoscopic characteristics of choledocholithiasis in Sri Lanka. Methods This was a retrospective study of consecutive patients for a period of three years until April 2016. The sample included patients from many parts of the island. Patients were selected from the endoscopy database of the unit and the data were collected from the records of the patients. Results A total of 253 patients were included in the study. The mean age of the patients was 53.6 years. Patients presented with obstructive jaundice (58.5%), cholangitis (25.3%), biliary colic or upper abdominal pain (14.2%) and acute biliary pancreatitis (1.8%). There were 26 (10.3%) post cholecystectomy patients. Concomitant gallbladder stones were found in 173 patients (68.4%). Juxta-papillary diverticula were found in 36 patients (14.2%). Twenty-one (8.3%) and nine patients (3.6%) were found to have choledochal cysts and common bile duct strictures, respectively. Stones were commonly found in the distal common bile duct (68.4%). A majority of the patients had a single stone (47.8%). In 209 patients (79.6%), the size of the largest stones measured between 0.5–1.5 cm. Conclusions Choledocholithiasis is a disease affecting middle-aged population with predominance among females in Sri Lanka. Patients with symptomatic choledocholithiasis commonly present with obstructive jaundice. In the present study, most of the stones were formed in anatomically normal biliary systems. Stones were predominantly distal, single and measured 0.5–1.5 cm in size. The observed features were favorable features for successful endoscopic clearance. None of the patients included in the study had primary CBD stones according to the available criteria.
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Affiliation(s)
| | - Ajith Aloka Pathirana
- Department of Surgery, Faculty of Medical Sciences, University of Sri Jayewardenepura, Colombo, Sri Lanka
| | - Thejana Kamil Wijerathne
- Department of Surgery, Faculty of Medical Sciences, University of Sri Jayewardenepura, Colombo, Sri Lanka
| | - Bawantha Dilshan Gamage
- Department of Surgery, Faculty of Medical Sciences, University of Sri Jayewardenepura, Colombo, Sri Lanka
| | | | - Mohan Malith De Silva
- Department of Surgery, Faculty of Medical Sciences, University of Sri Jayewardenepura, Colombo, Sri Lanka
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5
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Ando H, Takada T. Cystic Disorders of the Bile Ducts. SHACKELFORD'S SURGERY OF THE ALIMENTARY TRACT, 2 VOLUME SET 2019:1367-1377. [DOI: 10.1016/b978-0-323-40232-3.00116-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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6
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Abstract
Radiologic findings in 7 adult patients with bile duct cysts were reviewed. Endoscopic retrograde cholangiopancreatography (ERCP) was performed in 6 patients, percutaneous transhepatic cholangiography (PTC) in 4, CT and ultrasonography (US) in 4, and angiography in 6. ERCP and PTC were the only methods which exactly showed the extent of the cysts and the anomalous pancreatico-biliary junction present in 5 patients. ERCP and PTC were mandatory for surgical planning and treatment. Pancreas divisum was revealed in 3 patients, all of whom had suffered from acute pancreatitis. Intracystic adenocarcinoma was depicted at cholangiography in 2 patients. US and CT were valuable in showing cystic masses between the pancreatic head and the hilum of the liver, but in no patient was the diagnosis made by any of these methods. Angiography was performed for preoperative vascular mapping.
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7
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Hamidi S, Livingston MH, Alnaqi A, Yousef Y, Walton JM. Management of a massive choledochal cyst in a 12 year-old girl: Which imaging modalities should be performed preoperatively? JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2016. [DOI: 10.1016/j.epsc.2016.04.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Abstract
We report the case of a 31-year-old male with recurrent episodes of acute pancreatitis, subsequently discovered to have a rare type III choledochal cyst, also termed a choledochocele. This case demonstrates the utility of multiple imaging techniques to diagnose the correct etiology of the patient's pancreatitis, as well as to appropriately plan surgical intervention. For many years, endoscopic retrograde cholangeopancreatography has been the gold-standard for diagnosis of type III choledochal cysts; this procedure, however, carries a significant degree of morbidity and may perhaps be circumvented with the advent of advanced imaging techniques that allow for visualization of the intraduodenal portion of the biliary tract. In this case, CT and MR imaging demonstrated a spherical, cyst-like structure extending from the pancreatic duct into the second part of the duodenum, suggestive of a choledochocele. Presence of the choledochocele and its exact anatomy were confirmed with ERCP. This imaging, in combination with the appropriate clinical constellation of symptoms, enabled correct identification of the etiology of the patient's unexplained recurrent episodes of pancreatitis, allowing for appropriate and curative surgical intervention.
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9
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Abstract
Biliary cystic disease has been known of for centuries. It has traditionally been classified as 5 major types of disease, each with different clinical profiles and attributes. In this article, the basis for the existing classification schemes is reviewed and a simplified classification scheme and treatment regimen are suggested.
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Affiliation(s)
- Ronald F Martin
- Marshfield Clinic and Saint Joseph's Hospital, 1000 North Oak Avenue, Marshfield, WI 54449, USA; University of Wisconsin School of Medicine and Public Health, 640 Highland Avenue, Madison, WI, USA.
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10
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Soufi M, Lahlou MK, Chad B. [Cancer developed in cystic dilatation of the bile duct: report of a case]. Pan Afr Med J 2014; 19:346. [PMID: 25922635 PMCID: PMC4406382 DOI: 10.11604/pamj.2014.19.346.5110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 09/27/2014] [Indexed: 11/25/2022] Open
Abstract
Les auteurs rapportent un cas de dilatation kystique du cholédoque intra- pancréatique découvert chez une femme de 46 ans et compliqué d'un carcinome tubulo-papillaire n'envahissant pas le pancréas. Le traitement a consisté en une duodénopancréatectomie céphalique avec un curage ganglionnaire et anastomose hépatico-jéjunale; la survie était de 30 mois; les auteurs abordent les aspects radiologiques, anatomopathologiques, thérapeutiques et pronostiques de ces cancers développé sur dilatation kystique de la voie biliaire et discutent la place d'une radiothérapie complémentaire de la chirurgie susceptible d'améliorer la survie.
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Affiliation(s)
- Mehdi Soufi
- Division of Digestive Surgery, Oujda CHU, Faculty of Medicine, University Mohammed First, Oujda, Maroc
| | - Mohammed Khalid Lahlou
- Division of Digestive Surgery, Oujda CHU, Faculty of Medicine, University Mohammed First, Oujda, Maroc
| | - Bouziane Chad
- Division of Digestive Surgery, Oujda CHU, Faculty of Medicine, University Mohammed First, Oujda, Maroc
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11
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Ando H, Takada T. Cystic Disorders of the Bile Ducts. SHACKELFORD'S SURGERY OF THE ALIMENTARY TRACT 2013:1397-1404. [DOI: 10.1016/b978-1-4377-2206-2.00111-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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Tongprasert F, Traisrisilp K, Tongsong T. Prenatal diagnosis of choledochal cyst: a case report. JOURNAL OF CLINICAL ULTRASOUND : JCU 2012; 40:48-50. [PMID: 21688273 DOI: 10.1002/jcu.20856] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2010] [Accepted: 05/02/2011] [Indexed: 05/30/2023]
Abstract
Choledochal cyst is one of the intra-abdominal abnormalities of the biliary ducts that present as a cystic mass in the right upper quadrant abdomen. Prenatal diagnosis has been achieved by the demonstration of a connection between a dilated common bile duct and a cystic lesion. In this report, we describe a pregnant woman in whom routine fetal anomaly scan strongly suggested a choledochal cyst at 29 weeks of gestation by demonstrating a round cystic mass in the right upper quadrant of the abdomen, completely separated from the stomach, bowel loops, and gall bladder, and which showed a connection with the dilated common bile duct.
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Affiliation(s)
- Fuanglada Tongprasert
- Department of Obstetrics and Gynecology, Faculty of Medicine Chiang Mai University, Thailand
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13
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Imaging of biliary disorders in children. Pediatr Radiol 2011; 41:208-20. [PMID: 20865413 DOI: 10.1007/s00247-010-1829-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2010] [Revised: 07/22/2010] [Accepted: 08/17/2010] [Indexed: 12/22/2022]
Abstract
Biliary atresia and related disorders of the biliary tree, such as choledochal cyst, must be considered in the differential diagnosis of prolonged conjugated hyperbilirubinemia in infants and children. Pediatric biliary tract diseases include a variety of entities with a wide range of clinical presentations. Radiology plays an important role in the diagnosis and management of these pathologies. Unrecognized causes of biliary disease, like biliary atresia, can lead to liver transplantation during the first year of life. The aim of this article is to review the imaging of pediatric biliary disorders, including the implications of interventional radiology in some biliary diseases.
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Saad WEA, Wallace MJ, Wojak JC, Kundu S, Cardella JF. Quality improvement guidelines for percutaneous transhepatic cholangiography, biliary drainage, and percutaneous cholecystostomy. J Vasc Interv Radiol 2010; 21:789-95. [PMID: 20307987 DOI: 10.1016/j.jvir.2010.01.012] [Citation(s) in RCA: 214] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Revised: 01/03/2010] [Accepted: 01/13/2010] [Indexed: 02/06/2023] Open
Affiliation(s)
- Wael E A Saad
- Division of Vascular Interventional Radiology, Department of Radiology, University of Virginia Health System, Charlottesville, Virginia, USA.
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15
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Herman TE, Siegel MJ. Neonatal type 1 choledochal cyst. J Perinatol 2007; 27:453-4. [PMID: 17592488 DOI: 10.1038/sj.jp.7211759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- T E Herman
- Mallinckrodt Institute of Radiology, St Louis Children's Hospital Department of Radiology, Washington University School of Medicine, St Louis, MO 63110, USA.
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16
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Park JH, Lee DH, Kim HJ, Ko YT, Lim JW, Yang MH. Unilocular extrahepatic biliary cystadenoma mimicking choledochal cyst: a case report. Korean J Radiol 2006; 5:287-90. [PMID: 15637480 PMCID: PMC2698174 DOI: 10.3348/kjr.2004.5.4.287] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
We report here on a case of extrahepatic biliary cystadenoma arising from the common hepatic duct. A 42-year-old woman was evaluated by us to find the cause of her jaundice. Ultrasonography and CT showed a cystic dilatation of the common hepatic duct and also marked dilatation of the intrahepatic duct. Direct cholangiography demonstrated a large filling defect between the left hepatic duct and the common hepatic duct; dilatation of the intrahepatic duct was also demonstrated. Following excision of the cystic mass, it was pathologically confirmed as a unilocular biliary mucinous cystadenoma arising from the common hepatic duct.
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Affiliation(s)
- Ju-Hyun Park
- Department of Diagnostic Radiology, Kyung Hee University Hospital, Korea
| | - Dong Ho Lee
- Department of Diagnostic Radiology, Kyung Hee University Hospital, Korea
| | - Hyoung Jung Kim
- Department of Diagnostic Radiology, Kyung Hee University Hospital, Korea
| | - Young Tae Ko
- Department of Diagnostic Radiology, Kyung Hee University Hospital, Korea
| | - Joo Won Lim
- Department of Diagnostic Radiology, Kyung Hee University Hospital, Korea
| | - Moon-Ho Yang
- Department of Pathology, Kyung Hee University Hospital, Korea
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17
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Brancatelli G, Federle MP, Vilgrain V, Vullierme MP, Marin D, Lagalla R. Fibropolycystic liver disease: CT and MR imaging findings. Radiographics 2006; 25:659-70. [PMID: 15888616 DOI: 10.1148/rg.253045114] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Fibropolycystic liver disease encompasses a spectrum of related lesions of the liver and biliary tract that are caused by abnormal embryologic development of the ductal plates. These lesions (congenital hepatic fibrosis, biliary hamartomas, autosomal dominant polycystic disease, Caroli disease, choledochal cysts) can be clinically silent or can cause signs and symptoms such as cholangitis, portal hypertension, gastrointestinal bleeding, infections, and space-occupying masses. The different types of fibropolycystic liver disease demonstrate characteristic findings at computed tomography (CT) and magnetic resonance (MR) imaging. Patients with congenital hepatic fibrosis typically have imaging evidence of liver morphologic abnormalities, varices, splenomegaly, renal lesions, and other associated ductal plate abnormalities. Biliary hamartomas usually manifest as multiple cysts that are nearly uniform in size and measure up to 15 mm in diameter. Autosomal dominant polycystic disease typically manifests as an enlarged and diffusely cystic liver. In Caroli disease, cystic or fusiform dilatation of the intrahepatic ducts is seen, as well as the "central dot sign," which corresponds to a portal vein branch protruding into the lumen of a dilated bile duct. Choledochal cyst manifests as a fusiform or cystic dilatation of the extrahepatic bile duct. Awareness of these CT and MR imaging features is essential in detecting and differentiating between various fibropolycystic liver diseases and can assist in proper management.
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18
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Wong AMC, Cheung YC, Liu YH, Ng KK, Chan SC, Ng SH. Prenatal diagnosis of choledochal cyst using magnetic resonance imaging: A case report. World J Gastroenterol 2005; 11:5082-3. [PMID: 16124073 PMCID: PMC4321937 DOI: 10.3748/wjg.v11.i32.5082] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Choledochal cysts are congenital anomalies of the biliary ducts, characterized by cystic dilatation of the ducts. Prenatal diagnosis of this anomaly using ultrasonography (US) has been well documented. Magnetic resonance imaging (MRI) has recently become an important complement to US in prenatal diagnosis of fetal anomalies. We herein report a patient in whom at 24 wk’ gestation US suggested a right upper quadrant abdominal cyst and in whom at 26 wk’ gestation MRI more clearly delineated the cyst and its surrounding structures and suggested a choledochal cyst, which was confirmed at postnatal surgery and histopathology.
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Affiliation(s)
- Alex Mun-Ching Wong
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan, China
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19
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Abstract
Cystic diseases of the biliary tract encompass a complex group of congenital disorders. Some of the disorders, such as Caroli disease and the hepatobiliary cysts of autosomal-dominant polycystic kidney disease, share common embryologic origins, whereas others, such as choledochal cysts, biliary diverticula, and choledochoceles, have unclear origins. This article reviews the embryologic, clinical, pathologic, and imaging features of biliary cystic disease.
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Affiliation(s)
- Angela D Levy
- Department of Radiologic Pathology, Armed Forces Institute of Pathology, Washington, DC 20306, USA.
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Artigues Sánchez de Rojas E, Pareja Ibars E, Fabra Ramis R, Vázquez Prado A, Cárdenas Cauqui F, Trullenque Peris R. Tratamiento quirúrgico de la dilatación quística congénita de la vía biliar. Cir Esp 2003. [DOI: 10.1016/s0009-739x(03)72101-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Abstract
Imaging is a standard part of the evaluation of pediatric liver disease. Advances in MR imaging have improved the detection, characterization, and staging of hepatic lesions. Clinical information, however, is still important in selecting the best imaging study and in correctly interpreting the examination. This article addresses the clinical and imaging features of the common hepatic and biliary lesions in children. In addition, the techniques for performing hepatic MR imaging are reviewed.
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Affiliation(s)
- Marilyn J Siegel
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 South Kingshighway Boulevard, St. Louis, MO 63110, USA.
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22
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Abstract
PURPOSE This retrospective study was designed to classify choledochal cysts on the basis of the findings of hepatobiliary scintigraphy. METHODS Twenty-one patients with choledochal cysts (15 female, 6 male; mean age, 20 years) proved on the findings of endoscopic retrograde cholangiopancreatography (ERCP) or surgery and histopathologic analysis were included in the study. Two nuclear medicine physicians, blinded with regard to cholangiographic and operative details, were asked to review and to classify the type of choledochal cyst seen on the hepatobiliary scan. Later, scintigraphic results were compared with ERCP and surgical findings for a reference standard. RESULTS The findings of hepatobiliary scintigraphy correlated with ERCP and surgical findings in 18 of 21 cases (86%). Scintiscans correctly identified all type 1 cysts (12/12). The sensitivity of scintigraphy in diagnosing type 4 cysts was 66% (6 of 9 cases). It underestimated the intrahepatic extent of disease in type 4a biliary cysts (37%). CONCLUSION This study illustrates the utility of hepatobiliary scintigraphy in diagnosing type 1 and 4 choledochal cysts.
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Affiliation(s)
- A Rajnish
- Department of Nuclear Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Utter Pradesh, India
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23
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Abstract
High-resolution real-time ultrasonography (US) serves as an important tool for differentiation of obstructive and nonobstructive causes of jaundice in infants and children, independent of liver function. Unconjugated hyperbilirubinemia occurs in approximately 60% of normal term infants and in 80% of preterm infants. Persistence of neonatal jaundice beyond 2 weeks of age demands US evaluation to differentiate between the three most common causes: hepatitis, biliary atresia, and choledochal cyst. In all three conditions, the hepatic echotexture is diffusely coarse and hyperechoic, but this appearance may be seen in a variety of hepatic inflammatory, obstructive, and metabolic processes. Thus, hepatic scintigraphy and at times percutaneous liver biopsy are necessary to narrow the differential diagnosis and to identify patients who require more invasive techniques (eg, intraoperative cholangiography). US is useful for demonstrating inspissated bile and biliary duct stones. In infants, stones are usually secondary to obstructive congenital anomalies of the biliary tract, total parenteral nutrition, furosemide treatment, phototherapy, dehydration, infection, hemolytic anemia, and short-gut syndrome, whereas in older children, stones are usually associated with sickle cell disease, bowel resection, hemolytic anemia, and choledochal cyst. Jaundice in infants and children may also be due to cirrhosis, benign strictures, and neoplastic processes.
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Affiliation(s)
- J A Gubernick
- Department of Radiology, Albert Einstein Medical Center, Philadelphia, PA 19141-3098, USA
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Maharaj P, Khan O, Thomas A, Naipaul R. Cholangiocarcinoma in Association With Caroli's Disease. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 1999. [DOI: 10.1177/875647939901500203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Caroli's disease is a rare congenital disorder characterized by focal or diffuse dilatation of the intrahepatic bile ducts. If asymptomatic, this condition may remain undetected for several years. We present a case of focal Caroli's disease, first suspected on sonography, with a coexisting bile duct carcinoma. Both computed tomography (CT) imaging and percutaneous transhepatic cholangiography (PTC) supported a diagnosis of Caroli's disease but did not detect the presence of an associated mass, which was histologically proved to be a bile duct carcinoma. The advantages and disadvantages of different modalities in evaluating Caroli's disease are discussed.
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Affiliation(s)
- Paramanand Maharaj
- Department of Radiology, University of the West Indies, Uriah Butler Highway, Champs Flours, Mt. Hope, Trinidad
| | | | | | - Rene Naipaul
- Department of Radiology, University of the West Indies, Mt. Hope, Trinidad
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25
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Elton E, Howell D. Response. Gastrointest Endosc 1999; 49:414. [PMID: 10049436 DOI: 10.1016/s0016-5107(99)70031-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- E Elton
- University of Wisconsin, GI Section, Madison, Wisconsin
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26
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Elton E, Hanson BL, Biber BP, Howell DA. Dilated common channel syndrome: endoscopic diagnosis, treatment, and relationship to choledochocele formation. Gastrointest Endosc 1998; 47:471-8. [PMID: 9647371 DOI: 10.1016/s0016-5107(98)70247-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Choledochoceles (type III biliary cysts) are cystic dilations of the terminal common bile duct or common pancreatobiliary channel. Although no size criteria have been defined, it is generally assumed these must be large. However, we describe patients who do not meet the perceived size criteria for choledochoceles, but who nonetheless have a dilated common pancreatobiliary channel. METHODS We reviewed the presenting symptoms, endoscopic and radiographic findings, and response to endoscopic therapy of patients meeting our criteria for the dilated common channel syndrome. RESULTS Of 2847 patients undergoing ERCP, 100 (3.5%) had the dilated common channel syndrome. Common presenting symptoms and signs included abdominal pain in 97%, abnormal liver function test(s) in 66%, and a history of acute or recurrent pancreatitis in 46%. A bulge was visible above the papilla in 88%, with a dilated common bile duct in 54% and a dilated pancreatic duct in 28%. After endoscopic unroofing of the common channel, 77% had complete and long-lasting resolution of symptoms, 18% had partial or transient improvement, and 5% had no change. CONCLUSIONS Although classic choledochoceles are rare, a lesser degree of dilation of the common channel is more frequent than generally appreciated. We postulate that this finding represents an "incomplete," acquired form of choledochocele, possibly caused by underlying papillary stenosis. Whatever the etiology and appropriate term, the presence of a dilated common channel predicts a high rate of clinical response to endoscopic therapy.
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Affiliation(s)
- E Elton
- Department of Medicine/Division of Gastroenterology, Maine Medical Center, Portland, USA
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Abstract
We report a case of Caroli's disease associated with diverticulae and choledochocele of the common bile duct, a wide pancreaticobiliary angle and non-cirrhotic portal hypertension. This patient presented with recurrent episodes of cholangitis. To our knowledge, such a range of findings in the same patient has not been previously reported in the English language literature.
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Affiliation(s)
- R Gupta
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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28
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Affiliation(s)
- R Shlansky-Goldberg
- Department of Radiology, University of Pennsylvania Medical Center, Philadelphia 19104, USA
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29
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Affiliation(s)
- C A Mittelstaedt
- Department of Radiology, University of North Carolina Hospitals, University of North Carolina School of Medicine, Chapel Hill 27599, USA
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30
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Burke DR, Lewis CA, Cardella JF, Citron SJ, Drooz AT, Haskal ZJ, Husted JW, McCowan TC, van Moore A, Oglevie SB, Sacks D, Spies JB, Towbin RB, Bakai CW. Quality improvement guidelines for percutaneous transhepatic cholangiography and biliary drainage. Society of Cardiovascular and Interventional Radiology. J Vasc Interv Radiol 1997; 8:677-81. [PMID: 9232588 DOI: 10.1016/s1051-0443(97)70630-4] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
- D R Burke
- Society of Cardiovascular & Interventional Radiology, Fairfax, VA 22030, USA
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31
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Ando H, Kaneko K, Ito F, Seo T, Ito T. Operative treatment of congenital stenoses of the intrahepatic bile ducts in patients with choledochal cysts. Am J Surg 1997; 173:491-4. [PMID: 9207160 DOI: 10.1016/s0002-9610(97)00013-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Postoperative complications including intrahepatic calculi may develop after the complete excision of a choledochal cyst. Since congenital stenoses of the intrahepatic bile ducts are more likely the cause of intrahepatic calculi, operative procedures for intrahepatic stenoses are reported. METHODS There were 16 patients with choledochal cysts who underwent surgery for stenoses of intrahepatic bile ducts. The stenoses were excised at the opening of the common hepatic duct. RESULTS In the 16 patients, 25 of the 26 stenoses that involved an intraluminal membrane or septum could be excised from the divided end of the common hepatic duct at the hepatic hilum. In 1 patient, the stenosis could not be accessed from the hepatic hilum, and a left hepatic lobectomy was required. In postoperative follow-up, all 16 patients were in good health. CONCLUSIONS Stenoses of the intrahepatic bile ducts should be treated from the divided end of the common hepatic duct at the initial operation for choledochal cysts. The need for a second operation or hepatic lobectomy may thus be avoided.
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Affiliation(s)
- H Ando
- Department of Pediatric Surgery, University of Nagoya School of Medicine, Showa-ku, Japan
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32
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Gigot JF, Nagorney DM, Farnell MB, Moir C, Ilstrup D. Bile duct cysts: A changing spectrum of presentation. ACTA ACUST UNITED AC 1996. [DOI: 10.1007/bf02349784] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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33
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Abstract
This article discusses congenital and acquired disorders of the bile ducts and gallbladder in infants and children. Problems, such as extrahepatic biliary atresia, that are unique to infants are covered as well as distinctive aspects of hepatobiliary disease in older children. Biliary tract disease in the fetus and neonate presents an important challenge in that not only is hepatic structure and function disturbed but also the process of normal development may be retarded or altered by the disease process.
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Affiliation(s)
- C F McEvoy
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut 06520, USA
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34
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Cartagena AM, Levin TL, Weinberg G, Goldman HS. Choledochal cyst. Imaging by Telepaque-enhanced computed tomography. Clin Imaging 1993; 17:263-5. [PMID: 8111681 DOI: 10.1016/0899-7071(93)90066-v] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
A choledochal cyst is an uncommon anomaly of the biliary system requiring surgical intervention. A case of a choledochal cyst imaged by computed tomography following oral administration of cholangiography contrast material (Telepaque) is reported. Telepaque-enhanced computed tomography is an easy, noninvasive method to demonstrate pertinent preoperative anatomy in cases of choledochal cysts, and is especially useful in the pediatric patient.
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Affiliation(s)
- A M Cartagena
- Department of Radiology, Albert Einstein College of Medicine, Bronx, New York 10461
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Abstract
Hospital records of 24 Chinese infants and children (7 males and 17 females) with choledochal cysts were reviewed. The patients were aged 1 day to 17 years. Abdominal pain, palpable abdominal mass and jaundice, either alone or in combination, accounted for most of the initial presentations. Twenty-two patients were classified as type I with surgery, while the other two patients were type V without surgery. Ultrasonography is a rapid and accurate diagnostic method in the initial evaluation. Cyst excision with Roux-en-Y hepaticojejunostomy was the treatment of choice in this series. Chronic cholecystitis with or without inflammation of choledochal cyst was the most common pathological finding. Five patients underwent liver biopsies, showing four biliary cirrhosis and one portal fibrosis. So far, there is no evidence of malignancy in any patient.
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Affiliation(s)
- W J Shian
- Department of Pediatrics, Taichung Veterans General Hospital, Taiwan, Republic of China
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36
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Cohen GP, O'Donnell C. Malignant change within surgically drained choledochal cysts. AUSTRALASIAN RADIOLOGY 1992; 36:219-21. [PMID: 1332669 DOI: 10.1111/j.1440-1673.1992.tb03155.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- G P Cohen
- Department of Radiology, Alfred Hospital, Prahran, Victoria
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37
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Savader SJ, Venbrux AC, Benenati JF, Mitchell SE, Widlus DM, Cameron JL, Osterman FA. Choledochal cysts: role of noninvasive imaging, percutaneous transhepatic cholangiography, and percutaneous biliary drainage in diagnosis and treatment. J Vasc Interv Radiol 1991; 2:379-85. [PMID: 1799785 DOI: 10.1016/s1051-0443(91)72267-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Choledochal cysts are an uncommon anomaly of the biliary system; findings include cystic dilatation of the extrahepatic biliary tree, intrahepatic biliary tree, or both. In the past 7 years, 13 patients with choledochal cysts have been seen at the authors' institution for evaluation and presurgical intervention. Percutaneous transhepatic cholangiography (PTC) was performed in 13 patients. Sixteen percutaneous biliary drainage (PBD) procedures were performed in 11 patients, computed tomography was performed in six patients, and ultrasound was performed in two. PTC proved to be an important imaging modality because of its superior ability to define the cyst anatomy, site of biliary origin of the cyst, and extent and detail of both extrahepatic and intrahepatic disease, that is, intraductal strictures and calculi. PBD proved valuable in preoperative intervention, as an aid in surgical reconstruction, and in postoperative care. The role of these two modalities in the diagnosis and treatment of patients with choledochal cysts, in addition to clinical aspects of the disease, is discussed.
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Affiliation(s)
- S J Savader
- Russel H. Morgan Department of Radiology and Radiologic Sciences, Johns Hopkins Hospital, Baltimore, MD 21205
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