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Review
. 2014 Dec;219(6):1167-80.
doi: 10.1016/j.jamcollsurg.2014.04.023. Epub 2014 Jun 27.

Choledochal cysts: presentation, clinical differentiation, and management

Kevin C Soares  1 , Dean J Arnaoutakis  1 , Ihab Kamel  2 , Neda Rastegar  2 , Robert Anders  3 , Shishir Maithel  4 , Timothy M Pawlik  5
Affiliations
Review

Choledochal cysts: presentation, clinical differentiation, and management

Kevin C Soares et al. J Am Coll Surg. 2014 Dec.
No abstract available

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Figures

Figure 1
Figure 1
A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) diagram defining the method of inclusion and exclusion for studies used.
Figure 2
Figure 2
Common channel in a 4-year-old girl. (A) ERCP image revealing dilated intra- and extrahepatic ducts. Notice that the pancreatic duct (PD) drains (arrow) into the mid common duct (CD). (B) MRCP in the coronal oblique plane showing better delineation of the insertion point (arrow) of the pancreatic duct. The right (Rt) and left (Lt) intrahepatic ducts are also well visualized. Notice debris in the distal common duct.
Figure 3
Figure 3
Classification of choledochal cysts (CC). Type I cysts are fusiform dilatations of the common bile duct (CBD). Type II cysts are true diverticula of the CBD and type III CC (choledochoceles) are intraduodenal dilations of the common channel. Type IVA CC consist of multiple intrahepatic and extrahepatic biliary dilatations, while type IVB CC have extra-hepatic biliary dilatation with a normal intrahepatic biliary tree. Type V CC, or Caroli's disease, consist of cystic dilation of the intrahepatic biliary tree. RHD right hepatic duct, LHD left hepatic duct, CHD common hepatic duct, DUO duodenum.
Figure 4
Figure 4
Type I in a 53-year-old woman. (A) Thick slab (15 mm) minimum intensity projection CT image in the coronal oblique plane. There is diffuse dilatation of the common duct (arrow) consistent with type I choledochal cyst. The pancreatic duct (PD) is normal. (B) MRCP in the coronal oblique plane demonstrating similar findings. The gallbladder (GB) is also visualized. (C) ERCP image confirming diffuse dilatation of the common duct (arrow).
Figure 5
Figure 5
Type II in a 61-year-old female. (A) Thick slab (5mm) coronal reconstruction of CT image in the portal venous phase. Notice focal saccular outpouching in the distal common duct (arrow) consistent with Type II choledochal cyst. Notice that the pancreatic duct (PD) is draped around the cystic lesion which was originally mistaken for IPMN communicating with the pancreatic duct. (B) MRCP in the coronal oblique plane demonstrating the communication between the cyst and the distal common duct (arrow). No communication between the cyst and the pancreatic duct was visualized. (C) Axial MRCP image confirming the communication between the cyst and the distal common duct (arrow). The pancreatic duct (PD) does not communicate with the cyst.
Figure 6
Figure 6
Type IV in a 54-year-old woman. MRCP in the coronal plane shows multilobulated dilatation of the common duct (CD) with a short common channel noted inferiorly (arrow). Notice mild saccular dilatation of the intrahepatic right and left ducts. The pancreatic duct (PD) is not dilated.
Figure 7
Figure 7
Type V in a 27-year-old man. (A) Transverse ultrasound view of the liver demonstrating numerous anechoic lesions (arrows) scattered throughout the liver parenchyma. Ductal communication could not be detected. (B) MRCP in the axial plane demonstrating numerous small cysts, predominantly in the right lobe of the liver. These cysts are communicating with the intrahepatic bile ducts, which appear beaded (arrows). (C) MRCP image in the coronal plane showing communications between the cysts and the intrahepatic ducts (arrows). The kidneys are bright bilaterally (RK and LK) due to the presence of bilateral cystic renal disease.
Figure 8
Figure 8
Typical common duct (CD) cyst histology consists of relatively flat (line segment) or papillary columnar epithelium on type of a fibrous (F) wall. Chronic inflammation (white arrow), pyloric metaplasia (*), and reactive atypical epithelium (black arrow) are present in this example.
See this image and copyright information in PMC

Comment in

References

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