Multiple biliary hamartomas

Case contributed by Abeer Ahmed Alhelali
Diagnosis certain


Incidental finding on USS abdomen.

Patient Data

Age: 50 years
Gender: Male

Innumerable small well-defined round hypoechoic lesions noted throughout the liver, some of them showed comet tail artefact.


MRI liver without contrast was performed and showed the liver uniformly studded with innumerable non-communicating cystic lesions, the largest of which was seen in hepatic segment VII.

The cystic lesions were of low signal intensity on T1 images and very bright signal intensity on T2 images. The hepatic parenchyma showed a typical 'starry sky' like appearance.

Case Discussion

Multiple biliary hamartomas are considered as rare benign malformations of the intrahepatic bile ducts.

Biliary hamartomas appear as scattered small well-circumscribed lesions in ultrasound in the liver, with hypoechoic, hyperechoic, or mixed echogenicity depending on the components.

On ultrasound, a "comet tail” sign may be seen, which is a nonspecific sign for biliary hamartomas. On CT, biliary hamartomas are hypodense multiple small size lesions with irregular margins. On MRI, they are hypointense on T1-weighted imaging and hyperintense on T2-weighted imaging and show no enhancement after gadolinium MRCP shows multiple cystic lesions non-communicating with the biliary tree 1.

Special thanks to Dr Tamer Elholiby.

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