Choledochal cyst

Discussion:

Choledochal cyst, characterized by cystic dilation of extrahepatic bile duct, is considered a premalignant condition most often found during childhood. Clinically it can present conditions of jaundice, abdominal pain, and palpable abdominal mass. Multiple classifications for choledochal cyst exist however Todani's modified classification includes five types.

Type I:

  • Type IA involves cystic dilation of whole extrahepatic biliary tree with anomalous pancreaticobiliary junction.

  • Type IB involves segmental dilation of extrahepatic biliary tree without anomalous pancreaticobiliary junction.

  • Type IC involves diffuse fusiform dilation of the whole extrahepatic biliary tree with anomalous pancreaticobiliary junction.

Type II: Diverticular dilation anywhere along the extrahepatic duct.

Type III: (Choledochocele) Involves intraduodenal cystic dilation of the distal common bile duct.

Type IV:

  • Type IVA multiple dilations affecting both intra and extrahepatic biliary tree.

  • Type IVB involves multiple dilations confined to the extrahepatic biliary tree.

Type V: (Caroli's disease) Multiple dilations confined to the intrahepatic biliary tree.

For treatment, all choledochal cysts should be resected and bile flow should be restored.

 

This case was submitted with supervision and input from:
Soni C. Chawla, M.D.
Health Sciences Clinical Professor,
Department of Radiological Sciences,
David Geffen School of Medicine at UCLA.
Attending Radiologist,
Olive View - UCLA Medical Center.

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