Bile duct cyst
For patient information click here
| Bile duct cyst | |
 | |
|---|---|
| MRCP: Type 4 bile duct cyst. Image courtesy of RadsWiki |
|
Bile duct cyst Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Bile duct cyst On the Web |
|
American Roentgen Ray Society Images of Bile duct cyst |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]
Synonyms and keywords: Choledochal cysts
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Bile Duct Cyst from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
History, and Symptoms | Physical Examination |
Laboratory Findings
The laboratory tests are not specific and may show slightly abnormal liver function and cholestasis tests (serum bilirubin, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, γ-glutamyltranspeptidase) and amylase values.[1][2]
| X Ray |
CT |
CT scan of the abdominal cavity shows the relationship of the cyst with surrounding tissues, its continuity with the biliary tree, and the existence and staging of any accompanying malignancy. It is helpful to explain the intrahepatic dilations and the severity of the disease in people with Caroli’s disease (diffuse hepatic or localized segmental involvement) and type IVA cysts. Before doing an operation, a surgeon must consider certain factors since segmental lobectomy is a treatment option for localized type-IVA BC or Caroli's disease.
Though MRCP is superior to CTC cholangiography (Computerized tomography cholangiography (CTC) following infusion of meglumine iodoxamate), in the visualization of the intrahepatic duct and the pancreatic system according to research by Fumino et al., The greatest benefit of CTC, however, is its capacity to generate clear pictures free of respiratory aberrations in infants, in whom conducting an accurate MRCP is particularly challenging.[1][3]
MRI |
Ultrasound |
The first and most basic test is the USG. The diameter of the common bile duct, common hepatic duct, and BC can be measured, allowing imaging of the intrahepatic and extrahepatic bile ducts. It reveals a cystic mass in the right upper quadrant (often near the porta hepatis) that is distinct from the gallbladder (except for type-III and type-V cysts).
USG in prenatal diagnosis of Biliary cyst
It shows a spherical intra-abdominal cystic mass in the upper abdominal quadrant. According to the color Doppler USG, There is no discernible flow within the mass. It's essential to make an accurate early differential diagnosis between BC and other biliary diseases. The most important is BA(Biliary atresia) which is a surgical emergency. To distinguish between these two disorders, Tanaka et al. evaluated imaging (USG and CT) and laboratory tests in BC and BA. They came to the conclusion that patients who had biliary disorders smaller than 21 mm, total bile acid levels greater than 111 mol/L, and direct bilirubin levels greater than 2.5 mg/dL, in the neonatal period were more likely to have BA than BC and required emergent surgery to prevent irreversible liver cirrhosis.
Okada et al. by using an immunohistological analysis to discriminate between BC and BA, found that type-1 cystic BA contained biliary duct cells that were CD56-positive
Cholangiography | Cholangiography shows that the cyst is continuous with the biliary tract which allows distinguishing BC from other intra-abdominal cysts such as pancreatic pseudocysts, biliary cystadenomas, and echinococcal cysts. The different cholangiography techniques are Endoscopic retrograde cholangiopancreatography (ERCP), magnetic resonance-cholangiopancreatography (MRCP), percutaneous transhepatic cholangiography (PTC), and intraoperative cholangiography.
ERCP
ERCP
Although ERCP is an invasive procedure, it has the potential to be therapeutic. Any related intraductal disease or an APBJ is accurately revealed by this test. It is possible to simultaneously do a therapeutic papillotomy with a type III BC.
MRCP The investigation of choice for preoperative imaging of the biliary tree is MRCP, which is non-invasive. Gadoxetic acid-enhanced MRCP can show the physiology of bile excretion, in contrast to standard T2-weighted MRC, which uses heavily T2-weighted and fat-suppressed pictures to show fluid-filled space. It is linked to particular characteristics of the hepatocytes which absorb gadoxetic acid. The bile ducts are visible on hepatobiliary phase T1-weighted imaging because gadoxetic acid is discharged into them.
Treatment
Medical Therapy | Surgery | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies
Case Studies
- ↑ 1.0 1.1 Singham J, Yoshida EM, Scudamore CH (December 2009). "Choledochal cysts: part 2 of 3: Diagnosis". Can J Surg. 52 (6): 506–11. PMC 2792398. PMID 20011188.
- ↑ Kim OH, Chung HJ, Choi BG (January 1995). "Imaging of the choledochal cyst". Radiographics. 15 (1): 69–88. doi:10.1148/radiographics.15.1.7899614. PMID 7899614.
- ↑ Fumino S, Ono S, Kimura O, Deguchi E, Iwai N (July 2011). "Diagnostic impact of computed tomography cholangiography and magnetic resonance cholangiopancreatography on pancreaticobiliary maljunction". J Pediatr Surg. 46 (7): 1373–8. doi:10.1016/j.jpedsurg.2011.01.026. PMID 21763837.