Presentation
Upper abdominal pain for the last 6 months. No history of fever.
Patient Data
Liver: Enlarged size, normal in shape, outline, margin, and position. No focal cyst or SOL is seen in the liver parenchyma. Bilobar central and peripheral intrahepatic biliary radicals are dilated. No T2W hypointense filling defect is seen in the lumen. Hilar confluence is formed by joining RHD and LHD and forming common hepatic duct (CHD).
Gallbladder: Distended, normal wall thickness. No T2W hypointense filling defect is seen in the lumen. Cystic duct is dilated and communicates with CHD and forming common bile duct (CBD). Cystic duct appear dilated.
Common duct: Both CHD and CBD are dilated throughout their course with distal abrupt smooth narrowing after forming the ampulla. The maximum dimension of the common duct is 14.4 mm. No T2W hypointense filling defect is seen in the lumen.
Pancreatic duct: The main pancreatic duct and an accessory pancreatic duct join together and then join with the CBD and forming the ampulla. MPD appears dilated.
Case Discussion
In this case of intra-hepatic and extra-hepatic biliary duct dilatation in a 5-year-old female, the diagnosis is a choledochal cyst (modified Todani classification type 4a). Treatment is liver transplantation.
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