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CHOLEDOCHAL CYSTS RADIOLOGY
Category: Diagnostic Radiology
Abstract : Choledochal cyst Choledochal cysts are congenital dilations of the biliary tree that may present at any age, and can be diagnosed in the fetus during routine obstetric scanning. In the neonate the main presenting feature will be cholestatic jaundice but the classic triad of pain, jaundice and a palpable mass is more likely to be seen in the young adult. A number of types of choledochal cysts ha
Choledochal cyst
Choledochal cysts are congenital dilations of the biliary tree that may present at any age, and can be diagnosed in the fetus during routine obstetric scanning. In the neonate the main presenting feature will be cholestatic jaundice but the classic triad of pain, jaundice and a palpable mass is more likely to be seen in the young adult.
A number of types of choledochal cysts have been recognized and in many cases there is an anomalous insertion of the bile duct into the pancreatic duct of Wirsung.
On sonography a well-defined cyst will be identified close to the porta hepatis and in about 50% of patients there will be dilatation of the proximal bile ducts which may be seen to communicate directly with cyst.
Sludge or calculi may be seen within the cyst. Small choledochal cysts may be seen in association with biliary atresia but in these cases there will be no associated biliary tract dilatation. Definitive diagnosis is made by MR cholangiography, although scintigraphy and ERCP may be useful in difficult cases.
Other causes of cholestasis in children and neonates include bile duct stones (more common in girls), sclerosing cholangitis, CF, infections and Alagilles syndrome (a congenital paucity of the bile ducts). Acute cholestasis may also be caused by viral hepatitis, drugs, toxins, metabolic diseases or hypoxaemia.
Other causes of focal liver lesions
Liver metastases may occur from most paediatric malignancies, particularly neuroblastoma, rhabdomyosarcoma and Wilms tumour. Leukaemia and lymphoma may also cause focal defects in the liver. Liver involvement may be manifested by hepatomegaly with normal liver texture, a non-specific sign, or by diffuse coarsened liver texture with or without hepatomegaly.
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