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Gallstones and Choledocholithiasis

KEY FACTS Terminology Gallstones: Concretions within biliary system [gallbladder (GB) and biliary ducts] Cholesterol stones (75-80%) Pigment stones (20-25%) – "Black" stones in sterile GB; small; common in cirrhosis and hemolytic states – "Brown" stones in infected bile (e.g., recurrent pyogenic cholangitis) Sludge: Suspension of particulate material, crystals, and bile within GB Choledocholithiasis: Presence of stones in common bile duct (CBD); usually originate in GB Imaging…

Recurrent Pyogenic Cholangitis

KEY FACTS Terminology Repeated bouts of cholangitis, intra- and extrahepatic biliary ductal dilatation, and biliary calculi, typically in inhabitants of or immigrants from Southeast Asia You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

Caroli Disease

KEY FACTS Terminology Caroli disease : Congenital, multifocal, segmental, saccular dilation of large intrahepatic bile ducts (IHBDs) Type V choledochal cyst (Todani classification) Caroli syndrome (more common variant): Cystic bile duct dilation plus hepatic fibrosis (± portal hypertension) You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

Biliary Anomalies, Variants, and Artifacts

KEY FACTS Terminology Variants and artifacts that may simulate pathology or potentially complicate hepatobiliary surgical procedures Imaging Congenital anomalies of gallbladder (GB) Anomalies of number, shape, or position Most are of no clinical significance but may make surgery more difficult Normal biliary anatomy Left HD formed by segmental branches from segments II-IV Right HD has 2 branches, including horizontally oriented anterior branch draining segments V and…

Biliary System: Imaging Approach and Differential Diagnosis

Imaging Indications and Protocols Oral and IV cholangiography have been supplanted by newer cross-sectional imaging and cholescintigraphy. MR hepatobiliary IV contrast agents may be used to supplement CT or MR cholangiography. Cholescintigraphy is a nuclear medicine study used to evaluate the morphology and function of the biliary tree. In a " HIDA scan ," the patient receives an IV administration of Tc-99m iminodiacetic acid compound, an…

Hepatic Metastases and Lymphoma

KEY FACTS Imaging Multiphasic CT or MR are 1st-line tests Accuracy: Helical CT (~ 80%), MR and PET (~ 90%) Hepatic lymphoma Diffuse low density on CT may mimic steatosis – Easily distinguished from steatosis on MR Multiple well-defined, homogeneous, low-density (CECT) or high-intensity (T2WI) masses Liver metastases Hypovascular metastases: Low-density center with peripheral rim or target-like enhancement Hypervascular metastases: Hyperdense (intense) on arterial-phase CECT or…

Hepatocellular Carcinoma

KEY FACTS Imaging Patients with chronic liver disease must be in surveillance program (clinical & imaging) Small, curable hepatocellular carcinomas (HCCs) can be diagnosed by CT & MR Criteria for HCC are often specific enough to guide therapy without tissue confirmation Multiphasic contrast-enhanced CT or MR is definitive imaging study Key imaging features Hypervascular mass on arterial phase (CT or MR) with "washout" on venous &…

Hepatic Inflammatory Pseudotumor

KEY FACTS Terminology Heterogeneous group of lesions occurring in liver and bile ducts (among other organs) characterized by fibroblastic and myofibroblastic proliferation with inflammatory infiltrate You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here