Imaging Pearls ❯ Liver ❯ Liver Cysts and Cystic Disease
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- “ Congenital cystic lesions of the biliary tract include ductal plate malformations and choledochal cysts and can be recognized with characteristic imaging findings and basic knowledge of the embryologic development of the biliary tree.”
Congenital Cystic Lesions of the Biliary Tree
Santiago I et al.
AJR 2012; 198:825-835 - Congenital Cystic Lesions of the Biliary Tree
- Von Meyenburg complexes
- Congenital hepatic fibrosis
- Polycystic liver disease
- Caroli’s disease
- Choledochal cysts - Von Meyenburg Complex: Facts
- AKA biliary hamartomas
- Usually under 0.5 mm in size
- May be cystic, solid or mixed
- Do not communicate with the biliary tree - Congenital Hepatic Fibrosis: Facts
- Coomonly associated with PCKD
- Enlargement of portal spaces due to the presence of fibrosis and numerous more or less ectatic, abnormal bile ducts communicating with the biliary tree
- Portal hypertension without liver insufficiency
- Hypertrophy of lateral segment of left lobe and normal volume or hypertrophy of segments IVA and IVB - Polycystic Liver Disease: Facts
- 50% have associated PCKD
- Cysts enlarge after puberty
- Cysts may develop hemorrhage, infection or calcification
- Associated duct dilatation may also occur - Caroli’s Disease: Facts
- Autosomal recessive disease
- Dilated intrahepatic ducts up to 5 cm
- These dilated ducts may contain calcifications, sludge or both
- Cholangitis, cirrhosis and cholangiocarcinoma are potential complications
- “central duct sign” is classic finding
- Cystic Liver Lesions: Differential Diagnosis
Simple cyst
Complex cyst
-Neoplasm
-Biliary cystadenoma or cystadenocarcinoma
-Cystic metastases
-Hepatoma
-Cavernous hemangioma
-Embryonal
Inflammatory or infectious
Post-traumatic and miscellaneous
Cystic Lesions of the Liver
Vachha B et al.
AJR 2011;196:750-751 - Cystic Liver Lesions: Differential Diagnosis
Simple cyst
Complex cyst
-Inflammatory or infectious
-Post-traumatic and miscellaneous
Cystic Lesions of the Liver
Vachha B et al.
AJR 2011;196:750-751 - Cystic Liver Lesions: Differential Diagnosis
Simple cyst
-Benign developmental hepatic cyst
-Von Meyenburg complex
-Caroli disease
-Adult polycystic liver disease
Complex cyst
-Neoplasm
-Inflammatory or infectious
-Post-traumatic and miscellaneous
Cystic Lesions of the Liver
Vachha B et al.
AJR 2011;196:750-751 - Cystic Liver Lesions: Differential Diagnosis
Simple cyst
Complex cyst
-Neoplasm
-Inflammatory or infectious
-Post-traumatic and miscellaneous
Cystic Lesions of the Liver
Vachha B et al.
AJR 2011;196:750-751 - "The presence of upstream bile duct dilatation achieved the highest specificity (100%) for the differentiation of biliary cystic neoplasms from simple cysts, followed by THAD (84.6%), lesion location in the left lobe (76.9%) and coexistence of fewer than three other cysts (69.2%)"
Differentiation Between Biliary Cystic Neoplasms and Simple Cysts of the Liver: Accuracy of CT
Kim JY et al
AJR 2010; 195:1142-1148 - "Upstream bile duct dilatation, lesion location at the left hepatic lobe, fewer than three coexistent cysts, and THAD were found to be highly suggestive CT findings for the differentiation of biliary cystic neoplasms from hepatic cysts."
Differentiation Between Biliary Cystic Neoplasms and Simple Cysts of the Liver: Accuracy of CT
Kim JY et al
AJR 2010; 195:1142-1148