Presentation
Epigastric pain and jaundice.
Patient Data
Large well-circumscribed rounded multiloculated cystic mass centred on the left lobe of the liver, composed of numerous daughter cysts of various size mainly of peripheral location within the cystic matrix. Serpigenous linear structures of a low signal on T2 and T2 fat sat of the membranes within the mass. The postcontrast sequences show a regular peripheral enhancement.
Mild dilatation of the intrahepatic biliary ducts (IHBD) with a fistulous tract between the cyst and the IHBD well-demonstrated on postcontrast sequences indicating a cystobiliary communication. No dilatation of the CBD.
Two small hepatic haemangiomas of the segments, 5 and 7.
Small simple cortical right renal cyst.
Annotated image: the green arrow indicates the cystobiliary communication.
Case Discussion
MRI features of a large hepatic hydatid cyst with cystobiliary communication.
Intrabiliary rupture of hepatic hydatid cyst is a common complication of hepatic hydatid cysts. On imaging, it is important to appreciate the direct and indirect signs:
-
direct signs
- direct visualisation of cystobiliary communication (as in this case)
-
Indirect signs
- break in cyst wall adjacent to a bile duct
- biliary tree dilatation
- cystic material within the biliary tree or gallbladder
- distorted shape of cyst representing reduced intracystic pressure secondary to rupture
- presence of gas-fluid or fat-fluid level within the cyst
- displacement of bile ducts due to extrinsic pressure
- beak-like projection of cyst wall
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