Ultrasound Choledochal cysts

Most commonly found in children, this is associated with biliary atresia, in which the distal ‘blind’ end of the duct dilates into a rounded, cystic mass in response to raised intrahepatic pressure.
(A) This dilated CBD is obstructed by a mass (arrows) invading the lower end. (B) ERCP demonstrates a tight, malignant stricture, and can be used to position a palliative stent. (C) Stent in the CBD of a patient with a cholangiocarcinoma and malignant ascites. Decompression of the dilated biliary tree has been achieved, and ultrasound can be used to monitor the patency of the stent. Choledochal cysts in adults are rare, and tend to be asymptomatic unless associated with stones or other biliary disease. They are sometimes associated with an anomalous insertion of the CBD into the pancreatic duct. The mechanism of the subsequent choledochal cyst formation is unclear, but it is thought that the common channel, which drains into the duodenum, is prone to reflux of pancreatic enzymes into the biliary duct. This can cause a biliary stricture, with subsequent proximal dilatation of the duct, forming a choledochal cyst Fig. CC. Less commonly the dilatation is due to a nonobstructive cause in which the biliary ducts themselves become ectatic and can form diverticula. This may be due to a focal stricture of the duct which causes reflux and a localized enlargement of the duct proximal to the stricture. (See also Caroli’s disease,below, Complications of choledochal cysts include cholangitis, formation of stones and progression of the condition to secondary biliary cirrhosis, which may be associated with portal hypertension. It may be difficult to differentiate a choledochal cyst, particularly if solitary, from other causes of hepatic cysts. The connection between the choledochal cyst and the adjacent biliary duct may be demonstrated with careful scanning.
Fig. CC
Choledochal cyst. (These can sometimes be difficult to distinguish from a gallbladder, particularly if
large.) ULTRASOUND IMAGES choledochal cysts include cholangitis, ultrasound images of distinguish from a gallbladder, ultrasound images dilated CBD is obstructed by a mass
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