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-Choledochal cyst involving common bile duct (type IA). A, Percutaneous transhepatic cholangiogram shows extrahepatic location of cyst. Gallbladder (arrow) and cystic ducts are proximal to cyst. Common duct (arrowhead) distal to cyst is small. B, Enhanced CT scan shows low-density cyst (arrow) within pancreatic head.
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A classification scheme for choledochal cysts is outlined and their appearance on cholangiograms is illustrated. Choledochal cysts are uncommon anomalies of the biliary system and are probably congenital in origin. They are manifested by cystic dilatation of the extra- or intrahepatic biliary tree or both. The classification system described here d...
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Introduction
Endoscopic retrograde cholangiopancreatography associated with sphincterotomy and stone extraction with balloon or Dormia basket represents the gold standard for the management of common bile duct stones. The aim of our study were to investigate the predictors of failure of standard endoscopic techniques during the management of common...
Background
Biliary injuries remain a major concern in laparoscopic cholecystectomy. New intraoperative guidance modalities, including near-infrared fluorescence cholangiography, are under evaluation. Initial results showed limitations in visualizing the biliary tree in specific clinical situations. The aim of this study was to examine the feasibili...
Choledochal cyst is congenital dilatation of the biliary tract, present primarily in infants. This condition in pregnancy is very rare, and the clinical manifestations are nonspecific and variable. In late pregnancy, the symptoms may exacerbate due to hormonal effects and the compression of the common bile duct by the enlarging uterus. The need for...
Endoscopic therapy with endoscopic retrograde cholangiopancreatography (ERCP) has been suggested as an effective diagnostic and therapeutic tool for biliary and pancreatic disorders during pregnancy. In this report, we describe our experiences with pancreatobiliary endoscopic procedures during pregnancy.
We reviewed ERCP and endoscopic ultrasonogra...
Choledochal malformations (some of which are choledochal cysts) may be characterised as an abnormal dilatation of the biliary tract in the absence of acute obstruction. Most appear to be of congenital origin, probably related to distal bile duct stenosis, and almost 15% can now be detected antenatally. Excision and biliary reconstruction using a Ro...
Citations
... The adverse event rate for transhepatic cholangiography and biliary drainage can vary substantially with patient status before the procedure and diagnosis ( Table 6) (4,29,32,33,35,38,39,(60)(61)(62)(63)(64)(65)(67)(68)(69)(70)72,(90)(91)(92)(93)(94)(95)(96)(97). When 21-gauge or smaller needles are used, adverse events related to percutaneous transhepatic cholangiography have been reported to be low (17,29,34,39,(51)(52)(53). Patients with coagulopathies, cholangitis, stones, malignant obstruction, or proximal obstruction will have higher complication rates (19,61,93,94,98). ...
... Subtype IA shows saccular dilatation of the common bile duct. Subtype IB shows focal, segmental dilatation of the common bile duct.Subtype IC has fusi-form dilatation of the common hepatic and common bile duct[1,2].Type II cysts are a diverticulum of the CBD. TypeIII cysts are also referred to as choledochoceles, which show dilatation of the intra duodenal portion of the CBD. ...
... The Todani classification lists 5 types of CC: type 1, a pseudocystic dilatation of the extrahepatic bile duct (type 1A: fusiform, sac-like dilatation of the common bile duct; type 1-B: a diverticular dilatation of the common bile duct); type 2, a true cyst of the bile duct (lateral); type 3, a dilatation of the distal, intramural portion of the common bile duct (choledochocele); type 4, dilatation of both the extrahepatic and intrahepatic bile ducts; type 5, saccular dilatation(s) of the intrahepatic bile ducts. The overall incidence is very low with approximately one-third of reported cases been reported in Japanese population [2]. CC type 1 is the most commonly clinical presentation (70-90%), and results in most cases from a malformation of the common junction between the bile duct and the pancreatic duct (at the level of the duodenal wall where they join to form a (usually very short) common channel) [1]. ...
... Maternal medical and family histories were unremarkable. US examination was performed through standard Aloka (Aloka Co., Ltd, Tokyo, Japan) equipped with a curved linear array trans-abdominal transducer (2)(3)(4)(5) as well as with a transvaginal 4-8 MHz probe. ...
Choledochal cyst is an abnormality of the biliary ducts,
characterized by a dilatation of a portion of the biliary
ductal system (most commonly a portion or the whole of
the extrahepatic bile duct system) that presents usually at
ultrasonography as a cystic mass in the right upper
quadrant abdomen. Ultrasonographic prenatal diagnosis
may be challenging since the detection of any intraabdominal
cyst raises the issue of differential diagnosis
considering its nature as well as the organ of origin. In this
paper, we report our experience with a case of a
choledochal cyst strongly suspected during routine mid -
trimester ultrasound scan, when a round liquid mass was
found in the right upper quadrant of the abdomen; the
cyst was independent of the other intra-abdominal organs
but a connection was observed between the latter cyst
and dilated bile ducts. The diagnosis was confirmed at
birth and the infant underwent successful surgical
correction of the anomaly. We review the current
literature as well, discussing the current open challenges
of diagnosing and managing these cases.
... A choledochal cyst is a rare congenital anomaly of the biliary system, manifested as the cystic dilatation of bile ducts, usually occurring in the common bile duct (1)(2)(3)(4). The Todani classification system is widely used to classify choledochal cysts; however, not all cases fit into this classification system. ...
A choledochal cyst is a rare congenital anomaly of the biliary system manifested as the cystic dilatation of bile ducts, usually occurring in the common bile duct. Here, we describe an unusual type of choledochal cyst in a 45-year-old male that did not fit into the most widely accepted Todani classification of these cysts. The lesion mimicked duplication anomalies of the gallbladder and was finally diagnosed as a choledochal cyst involving the confluent portion of both intrahepatic ducts.
... La classification d´Alonso-lej, la plus souvent citée, date de 1959 et distingue 4 types [3]. Plus tard, Todani a proposé une classification modifiée, actuellement plus largement employée car tient compte de l´état des voies biliaires intra-hépatiques [4,5] (Figure 6). Cette classification de est utile pour l´analyse de la pathophysiologie et de la détermination de la stratégie thérapeutique [6]. ...
... La tomodensitométrie avec injection de produit de contraste permet dans ce cas de préciser la nature tissulaire d´un nodule pariétal et de détecter les toutes petites lésions [18]. La cholangio-pancréatographie per-endoscopique et/ou la cholangiographie transhépatique permettent de bien étudier l´anatomie des voies biliaires en particuliers intra-hépatiques et de préciser les deux extrémités de la dilatation et sa connexion avec le cholédoque sain [1,4,5,9]. Toute irrégularité ou sténose de la voie biliaire doit suggérer la malignité [1,18]. Le diagnostic peut être renforcé par l´examen cytologique de la bile obtenu au cours de ces deux procédures de cholangiographie [7,14]. ...
Les auteurs rapportent un cas de dilatation kystique du cholédoque intra-pancréatique découvert chez une femme de 46 ans et compliqué d'un carcinome tubulo-papillaire n'envahissant pas le pancréas. Le traitement a consisté en une duodénopancréatectomie céphalique avec un curage ganglionnaire et anastomose hépatico-jéjunale; la survie était de 30 mois; les auteurs abordent les aspects radiologiques, anatomopathologiques, thérapeutiques et pronostiques de ces cancers développé sur dilatation kystique de la voie biliaire et discutent la place d'une radiothérapie complémentaire de la chirurgie susceptible d'améliorer la survie.
... • Type V cysts, otherwise known as Caroli Disease, are characterized by intrahepatic biliary dilation, without extra hepatic involvement. [1,7,9,10] This case presented with type-IIIa disease. ...
... As mentioned previously, patients typically present with triad of abdominal pain, jaundice, and palpable abdominal mass. [1,4,6,7,9] However, these are seen in about 40% of cases. [6] This is partially responsible for delay in the diagnosis, as seen in this case. ...
... This is a rare complication of long-standing choledochal cyst. [9] Furthermore, surgery in the presence of portal hypertension is difficult due to the vascular collaterals in the region of the porta hepatis and is associated with significant morbidity and mortality. [9] The presence of complications contributes to significant morbidity and mortality, and to a large extent determines the modality of treatment in addition to other factors. ...
... The prevalence is of 1 in 13,000 hospital admissions. 1 Prenatal diagnosis of fetal choledochal cysts has become less rare with the improvement of the ultrasound (US) equipment as well as the increased use of routine fetal anomaly scan. Prenatal diagnosis of choledochal cysts is essential since this can lead to earlier surgical repair resulting in less complications. 2 ...
Choledochal cyst is one of the intra-abdominal abnormalities of the biliary ducts that present as a cystic mass in the right upper quadrant abdomen. Prenatal diagnosis has been achieved by the demonstration of a connection between a dilated common bile duct and a cystic lesion. In this report, we describe a pregnant woman in whom routine fetal anomaly scan strongly suggested a choledochal cyst at 29 weeks of gestation by demonstrating a round cystic mass in the right upper quadrant of the abdomen, completely separated from the stomach, bowel loops, and gall bladder, and which showed a connection with the dilated common bile duct.
... Subtype IB shows focal, segmental dilatation of the common bile duct. Subtype IC has fusiform dilatation of the common hepatic and common bile duct [17]. Type II cysts are a diverticulum of the CBD. ...
Choledochal cysts are a congenital anomaly, and they show dilatation of the intra- or extrahepatic biliary tree. These cysts are uncommon in Western countries, but are not rare in Asian countries. Choledochal cysts are classified into five groups based on location or shape of the cysts. Types I and IV-A cysts are the most common types, which are associated with anomalous pancreaticobiliary junction (APBJ), but other cysts are not associated with APBJ. Types I and IV-A cysts appear to belong to a different category from other cysts embryologically. Type I and IV-A cysts accompany anomalies of the pancreas. Type I and IV-A cysts might occur when left ventral anlage persists, and with disturbed recanalization of the common bile duct. Endoscopic retrograde cholangiopancreatography is the gold standard for detecting APBJ, but it is an invasive procedure. Magnetic resonance cholangiopancreatography (MRCP) is a non-invasive imaging tool for detecting pancreatic and biliary trees. MRCP is the first-choice modality for diagnosing choledochal cysts and APBJ in pediatric patients. Cystoenterostomy is been performed because of high complication and mortality rates. Complete excision of the cysts with Roux-en-Y hepatojejunostomy is a standard procedure for choledochal cysts to prevent postoperative complications, including development of cancer. In this study, we review classification, pathogenesis, diagnosis, and treatment of types I and IV-A choledochal cysts.
... Choledochal cysts were reportedly described first by Abraham Vater in 1723. 1 Choledochal cysts are cystic dilatations of the extrahepatic and intrahepatic biliary tree or both. They are approximately three times more common in women than in men. ...
... This comprises 80-90% of all choledochal cysts. 1 Todani type II are diverticular dilatations of the common bile duct. Todani type III is a choledocele, a malformation of the ampulla of Vater that does not have a high insertion of the pancreatic duct and common bile duct. ...
JPER is a multi-disciplinary journal that promotes the health of the preterm infant.
... Choledochal cysts are rare anomalies, characterized by cystic or fusiform dilatation of the intrahepatic and/or extrahepatic biliary tracts. These cysts have been classified into five major types [9] . Cystic dilatation of the common bile duct (type 1 choledochal cyst) comprises 80-90% of the cysts. ...
Choledochal cysts are congenital anomalies of the biliary ducts, characterized by cystic dilatation of the ducts. Prenatal diagnosis of this anomaly using ultrasonography (US) has been well documented. Magnetic resonance imaging (MRI) has recently become an important complement to US in prenatal diagnosis of fetal anomalies. We herein report a patient in whom at 24 wk’ gestation US suggested a right upper quadrant abdominal cyst and in whom at 26 wk’ gestation MRI more clearly delineated the cyst and its surrounding structures and suggested a choledochal cyst, which was confirmed at postnatal surgery and histopathology.
Keywords: Choledochal cyst, Prenatal diagnosis, MRI
Citation: Wong AMC, Cheung YC, Liu YH, Ng KK, Chan SC, Ng SH. Prenatal diagnosis of choledochal cyst using magnetic resonance imaging: A case report. World J Gastroenterol 2005; 11(32): 5082-5083
