MDCT of biliary cysts in children with biliary atresia: clinical associations and pathologic correlations

To evaluate the association of biliary cyst formation with cholangitis, portoenterostomy, biochemical abnormalities, using multidetector computed tomography (MDCT) and pathologic findings of end-stage liver disease.

We retrospectively reviewed the 42 MCDT studies, clinical history and laboratory findings of 36 children with biliary atresia.

Biliary cysts were detected in 58% of the patients on MDCT images. The cysts were not associated with cholangitis, portoenterostomy surgery, or biochemical abnormality. Hepatic artery anomaly was also common in our series (25%) and more common in patients with biliary cysts which was statistically significant (P < 0.05). Eighteen livers were available for pathologic examination. The only statistically significant finding between the patients with and without biliary cysts were biliary epithelial damage and inflammatory reaction around the cysts which were common in the patients with biliary cysts (P < 0.05).

The damage to the bile duct epithelium and inflammatory reaction around the biliary epithelium support the theory of obstruction and bile leaks in the etiogenesis of biliary cysts. This is the first report of the association between hepatic artery variations and the biliary cysts; this may be important in pretransplant evaluation.