Learning objectives
The main imaging findings in the diagnosis of choledochal cysts are shown,
together with a review of recent literature.
Background
Choledochal cysts are an uncommon abnormality defined as abnormal cystic dilation of intrahepatic,
extrahepatic bile duct,
or both [1].
This pathology occurs more frequently in childhood,
however it can occur in adults.
Choledochal cysts occur in about one in 100,000–150,000 births in Western countries.
The incidence is much higher in Asian countries,
approximately 1/1000,
with a greater predilection for women [2].
Multiple theories have been proposed to explain the physiopathogenesis,
however until now no single pathological mechanism has been found to explain them.
Anomalous pancreaticobiliary...
Findings and procedure details
We present illustrations of the classification of choledochal cysts,
together with the most representative findings in US,
CT and MRCP.
The classification proposed by Todani is the most used for its categorization,
dividing them into five groups (Fig. 1).
Type I is the most frequent,
representing 50 to 85%,
subdivided into 3 categories.
Type IA is a cystic dilatation of the entire extrahepatic biliary tree,
with preservation of the intrahepatic ducts (Fig. 2).Type IB is a focal or segmental dilatation of the extrahepatic bile duct,...
Conclusion
Choledochal cysts are uncommon bile duct abnormalities which occur more frequently in childhood.
They are benign entities but they should be removed due to risk of developing neoplasia,
especially cholangiocarcinoma,
and other pathologies such as choledocholithiasis,
cholangitis and pancreatitis.
Ultrasound,
computed tomography and especially MRCP allow Classification according to anatomic characteristics (Todani),
in groups with unequal malignant potential.
When a diagnosis of certainty can not be made,
gadoxetic acid enhanced MR- cholangiography can be used to determine whether fluid collections communicate with the biliary tree...
Personal information
Jesús Antonio Sanabria Delgado.
Hospital Italiano de Buenos Aires,
Argentina.
References
1.
Savader S,
Benenati J,
Venbrux A.
Choledochal Cysts: Classification and Cholangiographic Appearance.
AJR 156:327-331,
February 1991.
2.
Hukkinen M,
Koivusalo A,
Lindahl H,
et al.
Increasing occurrence of choledochal malformations in children: a single-center 37-year experience from Finland.
Scand J Gastroenterol 2014; 49:1255.
3.
Singham J,
Yoshida EM,
Scudamore CH.
Choledochal cysts: part 1 of 3: classification and pathogenesis.
Can J Surg 2009; 52:434.
4.
Yoon JH.
Magnetic resonance cholangiopancreatography diagnosis of choledochal cyst involving the cystic duct: report of three cases.
Br J...