Choledochal Cyst Associated with Cystic Duct Dilatation: Report of Three Cases

Traditionally, it has been accepted that choledochal cysts are cystic dilatations of the extrahepatic duct. The association of this anomaly with cystic dilatations of cystic duct is extremely rare. Here in three cases of choledochal cysts with cystic duct dilatations, unusual variant of choledochal cyst are described. In all three cases, MRCP showed that the dilated cystic duct communicates with a common duct through a wide opening.

Spontaneous Rupture of Choledochal Cyst: Case Report

Spontaneous rupture of a choledochal cyst leading to biliary peritonitis is a rare complication which can be fatal if not promptly diagnosed. The authors report the ultrasound and CT findings of two cases of spontaneous choledochal cystic rupture and the biliary peritonitis which ensued.

CT Findings of Malignancies Occurring in Choledochal Cysts: Differential Points with Benign Inflammations

PURPOSE: To demonstrate CT findings of malignancies occurring in choledochal cysts focusing on the differential points with benign inflammation. MATERIALS AND METHODS: The CT findings of seven patients with malignancies occurring in choledochal cysts(six cholangiocarcinomas and one cholangiohepatoma) and three with benign inflammatory wall thickening were reviewed. Six were studied with two-phase(arterial and portal) CT(threethe malignancies and all benign inflammations) and the remainder with conventional CT in the late portal or equilibrium phase. Spiral dynamic CT scans were performed in all two phase CT, except in the case of onemalignancy. The study was focused on the shape and enhancement pattern of the lesions and the presence of localinvasion or distant metastasis. RESULTS: Three of seven associated malignancies showed concentric wall thickening(mean wall thickness=11.3mm), two eccentric, wall thickening and two polypoid masses. Two of three arterial phase CT scans showed tumor enhancement and one showed low attenuating concentric wall thickening, well delineated from a strongly enhanced pancreas. In portal or delayed phase CT scans, all masses were isodense orslightly hypodense compared with the liver or pancreas. Extensive regional lymphadenopathy or distant metastasis was present in six patients at the time of diagnosis. Three cases of benign inflammatory wall thickening showed athinner wall(mean thickness=5mm), and two showed arterial enhancement of the inner wall with only, a diffuse and even pattern. On preoperative CT diagnosis, two cases of benign inflammatory wall thickening were misdiagnosed as malignancies. CONCLUSION: Concentric wall thickening type was the most difficult to differentiate from benign wall thickening. Irregular wall thickening of more than 10mm and enhancement of the whole thickeness of the wall is a reliable sign of malignancy. Dynamic spiral CT is essential for this evaluation.

Choledochal Cysts in Children: Pre- and Postoperative Radiological Evaluation

PURPOSE: To review the type, incidence and radiologic findings and to evaluate the clinical significance of intrahepatic duct dilatation of choledochal cysts in children. MATERIALS AND METHODS: Ultrasonography and operative cholangiography of 49 consecutive children with surgically confirmed choledochal cyst were reviewed and classified according to the Todani's classification. Patients with intrahepatic duct dilatation in preoperative evaluation were routinely followed by ultrasonography after surgery of extrahepatic bile duct. The status of bileduct was evaluated by comparing with the preoperative ultrasonography. RESULTS: According to the preoperative evaluation, there were 19 cases(39%) of type Ia, three cases(6%) of type Ib, ten cases(20%) of type Ic, 15 cases(31%) of type IVa, two cases(4%) of type V, but no case of the type II, III, IVb in Todani's classification.In twelve of 13 patients (five cases of type I and eight cases of type IVa) who had been followed up after surgery of choledochal cyst, the previously noted intrahepatic ductal dilatation were no longer seen. CONCLUSION: The incidence of the types of choledochal cysts by Todani's classification shows no significant difference between our result and the other authors'. The intrahepatic ductal dilatation seems to be reversible and mainly secondary to extrahepatic obstruction by choledochal cyst. Thus, postoperative follow up examination is more important than preoperative classification of bile duct dilatation.