Cystic disease of the liver may encompass many findings, including intra- and extrahepatic (renal and pancreatic) cysts and hepatic fibrosis. Choledochal cysts are a separate entity, although they may also exhibit a wide range of radiographic findings. Proposals regarding their cause include intrauterine bile duct obstruction, atypical junction of the pancreatic and common bile ducts (Fig. 232), an anomalous course of the primitive common bile duct through the duodenal wall, a malformed common bile duct, viral infections, and faulty recanalization of the primitive choleductus.55-59
Five different types of choledochal cysts have been described.60 Aneurysmal dilatation of the distal common bile duct, with or without proximal extension, is the most common60-62 (Fig. 2-32). Stasis within the dilated biliary tree may lead to the development of cholangio-
Fig. 2-27. Cystohepatic duct of Luschka.
Tube cholecystectomy study shows a short, tubular structure (the cholecystohepatic duct of Luschka) (arrow) arising from the superior aspect of the gallbladder and extending towards the liver parenchyma. No deformity of the gallbladder is seen to suggest a localized perforation. No extravasation is noted to infer filling of an arterial, venous, or lymphatic vessel. Multiple air bubbles were inadvertently introduced into the biliary tree during the performance of the examination.
Fig. 2-28. Wandering gallbladder.
Prone radiograph as a part of an oral cholecystogram reveals the opacified gallbladder (curved arrow) to Lie in the left upper pelvis. This excessive mobility represents a "wandering gallbladder."
Fig. 2-29. Intrahepatic gallbladder.
(a) Radionuclide sulfur colloid liver-spleen scan shows a photon deficient area high in the right lobe of the liver.
(b) Film of the right upper quadrant from an intravenous cholangiogram confirms an intrahepatic gallbladder (arrows) as the cause.
(From Javors BR.3)
carcinoma. A choledochocele (Figs. 2-33 and 2-34), similar in appearance to a simple ureterocele, multifocal segmental dilatation, and Caroli's disease are other less common types of choledochal cysts. Caroli's disease is characterized by segmental dilatation of the intrahepatic ducts. Recurrent bouts of cholangitis secondary to stasis within the ducts are a common complication of Caroli's disease. Rarest of choledochal cysts is a distal common bile duct diverticulum.
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