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Imaging of the choledochal cyst
1Department of Diagnostic Radiology, Ajou University College of Medicine, Suwon, Korea.
Insights
Choledochal cysts are rare congenital dilations of the bile duct, often diagnosed in infancy. Imaging techniques like ultrasonography and CT scans help identify these pancreaticobiliary anomalies.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Radiology
Background:
- Choledochal cysts are rare congenital biliary tract malformations.
- They typically present in infancy and childhood with symptoms related to bile duct obstruction or pancreatitis.
Purpose of the Study:
- To review the diagnostic modalities for choledochal cysts.
- To discuss the etiology and imaging characteristics of choledochal cysts.
Main Methods:
- Review of imaging techniques including radiography, ultrasonography, computed tomography, hepatobiliary scintigraphy, and cholangiography.
- Discussion of the pathophysiology related to pancreaticobiliary ductal junction anomalies.
Main Results:
- Ultrasonography is the preferred initial imaging modality for detecting bile duct dilatation.
- CT scans offer detailed visualization of the intrahepatic biliary tree.
- Cholangiography (ERCP, PTC, intraoperative) provides definitive anatomical detail of the biliary tree and pancreaticobiliary junction.
Conclusions:
- Choledochal cysts are congenital anomalies often linked to abnormal pancreaticobiliary ductal union.
- A combination of imaging modalities is essential for accurate diagnosis and surgical planning.
Abstract:
Choledochal cysts are rare and usually manifest in infancy and childhood. They are considered congenital because they occur in fetuses and neonates. Their origin may be related to an abnormal connection between the pancreatic duct and common bile duct and chronic reflux of pancreatic juice into the bile duct, resulting in irritation of the duct and subsequent dilatation. Choledochal cysts appear as cystic or fusiform dilatation of the common bile duct at radiography. Ultrasonography is the best initial method of evaluating dilatation of the intra- and extrahepatic bile ducts. Computed tomography is considered to be more accurate in delineating the intrahepatic biliary tree. Hepatobiliary scintigraphy with technetium-99m disofenin provides physiologic information on hepatic uptake and accumulation of radionuclide in the dilated biliary tree. Endoscopic retrograde cholangiopancreatography, percutaneous transhepatic cholangiography, and intraoperative cholangiography are definitive studies that demonstrate anatomic details of the biliary tree and the pancreaticobiliary ductal junction.