Ultrasound images Choledochal cyst paediatric abdomen

Choledochal cysts are congenital dilations of the biliary tree that may present at any age, and can be diagnosed in the fetus during routine obstetric scanning. In the neonate the main presenting feature will be cholestatic jaundice but the classic triad of pain, jaundice and a palpable mass is more likely to be seen in the young adult. A number of types of choledochal cysts have been recognized and in many cases there is an anomalous insertion of the bile duct into the pancreatic duct of Wirsung. On sonography a well-defined cyst will be identified close to the porta hepatis and in about 50% of
patients there will be dilatation of the proximal bile ducts which may be seen to communicate directly with cyst (Fig.ultrasound images below).
ultrasound images of Large choledochal cyst at the porta hepatis Sludge or calculi may be seen.
within the cyst. Small choledochal cysts may be seen in association with biliary atresia but in these cases there will be no associated biliary tract dilatation (Fig. ultrasound images below).
ultrasound images of Intrahepatic choledochal cysts in biliary atresia with no proximal biliary tract dilatation.
Definitive diagnosis is made by MR cholangiography, although scintigraphy and ERCP may be useful in difficult cases.  Other causes of cholestasis in children and neonates include bile duct stones (more common in girls), sclerosing cholangitis, CF, infections and Alagille’s syndrome (a congenital paucity of the bile ducts). Acute cholestasis may also be caused by viral hepatitis, drugs, toxins,metabolic diseases or hypoxaemia.

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