Magnetic resonance cholangiopancreatography diagnosis of choledochal cyst involving the cystic duct: report of three cases

Abstract

ABSTRACT. Here we describe three cases of choledochal cyst involving the cystic duct or isolated dilatation of the cystic duct. All cases were visualised on MR cholangiopancreatography (MRCP) imaging. We report findings of ultrasonography, CT and MRCP. These cases are extremely rare; nine cases have been reported in the English-language literature. This anomaly was not included in Todani's classifications of choledochal cysts, a system that is accepted worldwide. We think that this variant anomaly will be included in this classification system in the near future. ; normal range ,10 ng ml -1 ) was noted. Initial work-up included a transabdominal ultrasonography, which showed a hypoechoic mass replacing the fundal portion of the gallbladder ( Figure 1a). On abdominal CT, a soft-tissue mass was noted in the fundus of the gallbladder with suspicion of hepatic invasion ( Figure 1b); multiple enlarged lymph nodes were identified in the peripancreatic, portocaval, aortocaval, and left paraaortic regions ( Figure 1b), suggesting the possibility of malignancy.Focal fusiform dilatation of the cystic duct without a definite cause of obstruction was identified and was about 22 mm in diameter and 34 mm in length (Figure 1c).The extrahepatic bile duct and common bile duct were of normal diameter.MR cholangiopancreatography (MRCP) was performed for further evaluation. On thick-slab coronal oblique MRCP imaging, fusiform dilatation of the cystic duct with normal diameters for the intrahepatic and extrahepatic bile ducts was seen (Figure 1d).There was no evidence of bile duct stone or stenosis in the transitional portion of the cystic duct. Also, there was no evidence of definite anomalous union of the pancreaticobile duct (AUPBD). This patient was diagnosed with advanced gallbladder cancer with lymph nodes metastasis combined with choledochal cyst involving the cystic duct only. Case 2A 48-year-old woman was transferred from a local clinic because of bile duct dilatation. The patient complained of intermittent dyspepsia and mild abdominal pain for 6 weeks. But there was no definite tender point or Murphy's sign on physical examination. On CT scan performed at an outside institution, mild wall thickening of the gallbladder was identified with luminal contraction and suspicion of gallbladder stones. Demonstrable dilatation of the common bile duct was present with normal appearance of the intrahepatic bile duct and pancreatic duct. The laboratory findings showed an increased level of total bilirubin (1.2 mg dl ); other laboratory results including serum tumour markers were within normal limits. Abdominal MRI (Figure 2a) and MRCP ( Figure 2b) were performed, showing fusiform dilatation of the common bile duct and cystic duct of about 7 cm in length and 3 cm in diameter; the ducts were joined by a wide opening, but no visible cause of obstruction was identified. There was no evidence of definite AUPBD. After 1 week of clinical observation, the total bilirubin level returned to normal. The patient was conservatively treated for 5 ye...

A variant of type VI choledochal cyst: combined dilatation of cystic duct and common bile duct

“…Ethical standards All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 (5). No animals were used during the study.…”

“…Combined dilatation of the cystic duct and the common bile duct (as seen in our case) is extremely rare and though documented in few case reports, it has not yet been included in the (Todani) classification of choledochal cysts. Yoon in 2011 [5] described the imaging features of choledochal cysts with involvement of the cystic duct in three cases; in one of the case only cystic duct was dilated and in other two both the cystic and common bile ducts were involved, and proposed that these variant anomalies be included in the classification of choledochal cysts.…”

A New Variant of Choledochal Cyst Diagnosed on Magnetic Resonance Cholangiopancreatography

“…The tremendous advancements in imaging technology have resulted in incidental detection of a number of new variants most of which include involvement of cystic duct. However, all the previous literature is either on isolated cystic duct involvement or the involvement of cystic duct along with extra hepatic duct involvement [4][5][6][7]. The present case was unique as there was involvement of cystic duct along with bilobar central intra hepatic bile ducts [Table/ Fig-2].…”

Another Type of Choledochal Cyst Beyond the Todani Classification

“…Yoon first made a proper diagnosis preoperatively for 3 patients with the use of MRCP. 7 Praveen Maheshwari 5 correctly preoperatively identified 10 cases using abdominal Doppler ultrasonography combined with MRCP or multidetector computed tomography (MDCT). Once any nonvascular cystic structure is found close to the porta hepatis, its relationship with the gall bladder, cystic duct, and common bile duct should be thoroughly determined.…”