Multiple biliary hamartomas

Case contributed by Dr Paul Simkin

Presentation

Porta hepatis cystic lesion for investigation.

Patient Data

Age: 36
Gender: Male
CT

Gallstones within the body and fundus of the gallbladder with the adjacent gallbladder contracted around the gallstones. The described cystic lesion within the porta hepatis represents the residual non-contracted proximal gallbladder. Multifocal small 3-4 mm hypodensities throughout the liver parenchyma with progressively enhancing liver parenchyma within segment 7 which may relate to Von-Meyenburg complex (biliary hamartosis).

Ultrasound
The liver contains innumerable small echogenic "nodules"measuring up to 3 mm in both lobes. There are also several small cysts. There is no convincing liver surface or hepatic vein wall nodularity. Portal vein Doppler is unremarkable with no evidence of portal hypertension. Large gallbladder calculi noted.
MRI
Innumerable tiny T2 hyperintense lesions throughout the liver parenchyma measuring between 2-10 mm consistent with biliary hamartomas. The lesions are most marked within a subcapsular distribution throughout the right lobe. No intrahepatic or extrahepatic biliary duct dilatation. Similar to the previous CT study there is gallstone is present within the fundus of the gallbladder. Spleen, adrenals, kidneys, pancreas, pancreatic duct and visualised bowel are within normal limits. Impression: Multiple biliary hamartomas consistent with Von Meyenburg complex.
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Case information

rID: 49423
Case created: 23rd Nov 2016
Last edited: 29th Mar 2017
Inclusion in quiz mode: Included

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