Multiple biliary hamartomas
40 year old lady with ongoing right upper quadrant fullness and mildly deranged LFT's. Multiple indeterminate liver lesions were identified on ultrasound. MRI liver was recommended for further evaluation of these lesions.
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Innumerable T1 hypointense with no post contrast enhancement and T2 hyperintense hepatic lesions with irregular walls. The liver is of normal size. Gallbladder fundus septation. No biliary tree obstruction. Two pancreatic branch type IPMT's are noted. Renal bilateral simple cysts.
The images demonstrate T1 hypointense with no post contrast enhancement and T2 hyperintense multiple hepatic lesions which represent multiple biliary hamartomas.
Differential diagnosis includes:
- metastases - which in most of the cases enhance vividly post contrast administration
- multiple cysts - the wall is usually imperceptible
- biliary cystadenomas - less numerable and of variable T1/T2 intensity
- multiple micro-abscesses - typically restriction on DWI sequences