Choledochal Cyst

  • Etiology: common channel
  • Types – 1. fusiform dilation of common bile duct (80-90%), 2. common bile duct diverticulum, 3. choledochocoele (intraduodenal diverticulum), 4. cystic dilation of intrahepatic and or extrahepatic ducts / Caroli’s disease
  • US: cystic mass in the liver that appears to communicate with the biliary tree
  • HIDA scan: radiotracer uptake in the lesion, confirming its communication with the biliary tree
  • Complications: stasis, stones, cholangitis, pancreatitis, malignancy (rhabdomyosarcoma in kids, cholangiocarcinoma in adults)
  • Clinical: classic triad is pain, jaundice, and RUQ mass
  • Clinical: presentation varies with age
    — Infant – jaundice + acholic stool
    — Child – biliary obstruction, jaundice, RUQ mass – or – recurrent pancreatitis – or – pain
    — Adult – pain

Cases of Choledochal Cyst

US and nuclear medicine scan of choledochal cyst
Sagittal US of the liver (left) shows a cystic mass in the liver that appeared to communicate with the biliary tree. Image from a hepatobiliary scan (right) shows radiotracer uptake in the lesion, confirming its communication with the biliary tree.
US of choledochal cyst
Transverse US of the liver shows a cystic lesion distinct from the gallbladder in the liver. Hepatobiliary imaging showed it communicating with the biliary tree.