CHOLEDOCHAL CYST

5 YRS CHILD WITH PAIN ABDOMEN AND JAUNDICE



Fusiform dilatation of common hepatic duct and proximal common bile duct with multiple stones within it- s/o type I choledochal cyst with choledocholithiasis. Edema of gall bladder wall- s/o cholecystitis



·        The widely accepted classification system for choledochal cysts, which was devised by Todani et al is based on the cholangiographic morphology, location, and number of intrahepatic and extrahepatic bile duct cysts.

·        Type I cysts are confined to the extrahepatic bile duct (EHD) and can be further subdivided into IA, IB and IC

·        IA cyst involves the entire EHD, IB involves only a focal segment of the EHD, and IC involves only the CBD.

·        Type II cysts are true diverticula of the EHD.

·        Type III cysts are also referred to as choledochocele and are confined to the EHD within the duodenal wall.

·        Type IV cysts have multiple features which can include both an extrahepatic and intrahepatic component.

·        Type IV cysts can be further subdivided into type IVA involving both the EHD and intrahepatic bile duct, as well as type IVB, involving multiple segmental dilatations of the EHD.

·        Type V (Calori's disease) cysts are confined to the IHD

·        Complications :

1.     Cholecystitis

2.     Recurrent cholangitis

3.     Biliary stricture

4.     Choledocholithiasis

5.     Recurrent acute pancreatitis

6.     Malignant transformation into cholangiocarcinoma

References:

Imaging Features of Adult Choledochal Cysts: a Pictorial Review, Korean J Radiol. 2009 Jan-Feb; 10(1): 71–80.