Choledochal cyst - type IVa with anomalous pancreaticobiliary junction
Presentation
Pain abdomen and jaundice.
Patient Data
There is diffuse fusiform dilatation of right, left hepatic ducts, common hepatic duct and proximal, middle third of CBD maximum diameter measuring 37 mm with mild IHBD and proximal CBD calculi largest measuring ~12-13 mm in keeping with Type 4a choledochal cyst
There is associated anomalous pancreatico-biliary junction with stenotic distal CBD and common channel length measuring approximately 15 mm with a hypo-intense calculus measuring ~11-12 mm.
Cholelithiasis with no cholecystitis.
Diffuse prominence of cystic duct with cystic duct calculi.
Pancreatic parenchyma appears mildly atrophic with prominent MPD (diameter 2-3mm) and hyper-intense areas within representing acute on chronic pancreatitis.
Case Discussion
The patient presented with jaundice and repeated attacks of pain abdomen. This case emphasizes association between type 4a choledochal cyst and anomalous pancreaticobiliary junction with stenotic distal CBD, and relatively rare finding of calculus in common channel.