Unit 7 - Pathology of Biliary Tree & Dilated Ducts ~ Elie

Is a Choledochal Cyst acquired or congenital?

Congenital

A choledochal cyst is the result of?

Pancreatic juices refluxing into bile duct

How are choledochal cysts formed?

By weakening & “outpouching”

What is the sonographic appearance of a Choledochal Cyst?

•True cysts in RUQ

•Enlarged CBD, CHD

What is this sonographic image showing?

Choledochal Cysts

What is Caroli’s Disease

A rare congenital abnormality

Is Caroli’s Disease acquired or inherited?

Inherited

In Caroli’s disease, it is characterized by congenital segmental saccular cystic dilation of _________ ____ _____

Intrahepatic bile ducts

Caroli’s Disease is most prevalent in:

young adult or pediatric population

Caroli’s disease is associated with:

•renal disease (medullary sponge) or congenital hepatic fibrosis

What is the symptoms associated with Caroli’s Disease?

Recurrent cramp-like upper abdominal pain

What is recurrent cramp-like upper abdominal pain secondary too?

Biliary stasis, ductal stones, cholangitis, & hepatic fibrosis

What are the two types of Caroli’s Disease?

•Simple classic form

•Associated with periportal hepatic fibrosis (more common)

Caroli’s Disease US findings: what is seen in the area of the ductal system as converges toward porta hepatis?

Multiple cystic structure

Caroli’s Disease US findings: what type of scattered cysts communicate with bile ducts?

Localized or diffusely

Caroli’s Disease US findings: ducts may show _______ appearance as they extend into periphery of liver

Beaded appearance

Caroli’s Disease US findings: What may be present?

Ectasia of extrahepatic & CBD

Caroli’s Disease US findings: What may reside in the dilated ducts?

Sludge or calculi

What is the differential diagnosis for Caroli’s Disease?

Polycystic liver disease

Dilated Ducts US findings in non-jaundiced patients:

• Minimal dilation

  • With gallstones or tumor

  • Intermittent stone obstruction

What disease is this sonographic image showing?

Caroli’s Disease

In this ultrasound image what is being displayed?

Caroli’s Disease

In the image above, what is being shown?

Dilated Ducts

What is the most common cause of a biliary obstruction?

Presence of tumor or thrombus within ductal system

A biliary obstruction can either be _________ or ________:

Extrahepatic or Intrahepatic

What does a biliary obstruction look like on US?

• Ductal Dilation

• “Too many tubes” or “shotgun”

In an extrahepatic biliary obstruction, what is the sonographer’s job?

To localize level and cause

What are the three primary areas for an extrahepatic biliary obstruction?

• Intrapancreatic

• Suprapancreatic

• Porta Hepatic

What is a subpancreatic obstruction?

An obstruction between pancreas & porta hepatis

What is a Porta Hepatic obstruction?

Obstruction at this level shows intrahepatic ductal dilation & a normal Common duct, Hydrops of GB possible

What is Mirizzi syndrome?

an uncommon extrahepatic obstruction

What is Mirizzi syndrome impacted by?

Stone in the cystic duct or GB neck

What can Mirizzi syndrome cause?

Extrinsic compression of CHD

Painful jaundice is a common symptom of what?

Mirizzi Syndrome

Mirizzi Syndrome US findings:

• Intrahepatic ductal dilation

• Normal-size common duct

• Large stone in neck of GB or cystic duct

Extrahepatic Biliary Obstruction US findings with minimal dilation: In nonjaundiced patients present with?

Gallstones or pancreatitis

Extrahepatic Biliary Obstruction US findings with minimal dilation: In jaundiced patients, they present with?

Common duct stone or tumor

Extrahepatic Biliary Obstruction US findings: a diameter greater than ___mm suggests an obstruction by a stone or tumor of the duct, pancreas, or other source

11mm

Extrahepatic Biliary Obstruction US findings: What are other reasons to why a duct may enlarge?

Age and post cholecystectomy

What are the sonographic characteristics of dilated ducts?

• Alteration in anatomic pattern at portal bifurcation

• Irregular walls of dilated bile ducts

• Stellate confluence of dilated ducts

• Acoustic enhancement by dilated ducts

• Peripheral duct dilation

What is being shown in the image above?

A mass in porta hepatis