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Case 22 - Peribiliary cysts

from Section 3 - Biliary system

Published online by Cambridge University Press:  05 November 2011

Fergus V. Coakley
Fergus V. Coakley
Affiliation:
University of California, San Francisco
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Summary

Imaging description

Peribiliary cysts are small (2–20 mm) thin-walled non-communicating retention cysts of the serous glands adjacent to the intrahepatic bile ducts [1,2]. If numerous and contiguous, these periductal cysts result in an appearance of periportal fluid-filled tubes that may mimic biliary dilatation (including Caroli's disease) or periportal edema (Figures 22.1 and 22.2) [3–6].

Importance

Peribilary cysts are usually inconsequential, and only matter insofar as they mimic more serious pathology or may be markers of associated underlying disease. Rarely, peribiliary cysts may cause biliary obstruction [7, 8].

Typical clinical scenario

Peribiliary cysts usually occur in patients over 50 and are reportedly commoner in men [3]. They may be idiopathic or secondary to adult polycystic disease (Figures 22.3 and 22.4), cirrhosis, idiopathic portal hypertension, extrahepatic biliary obstruction, systemic infection, or liver metastases [9].

Differential diagnosis

While peribiliary cysts can closely mimic biliary dilatation, close inspection may show that the periportal findings are on both sides of the portal vein branches (Figures 22.1 and 22.4), in contrast to dilated bile ducts which are only visible on one side of the portal vein branches. CT cholangiography can elegantly confirm the diagnosis by opacifying the bile ducts and documenting that they are distinct to the peribiliary cysts (Figures 22.1 and 22.2) [3].

Type
Chapter
Information
Pearls and Pitfalls in Abdominal Imaging
Pseudotumors, Variants and Other Difficult Diagnoses
 , pp. 72 - 75
Publisher: Cambridge University Press
Print publication year: 2010

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References

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  • Peribiliary cysts
  • Fergus V. Coakley, University of California, San Francisco
  • Book: Pearls and Pitfalls in Abdominal Imaging
  • Online publication: 05 November 2011
  • Chapter DOI: https://doi.org/10.1017/CBO9780511763229.023
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  • Peribiliary cysts
  • Fergus V. Coakley, University of California, San Francisco
  • Book: Pearls and Pitfalls in Abdominal Imaging
  • Online publication: 05 November 2011
  • Chapter DOI: https://doi.org/10.1017/CBO9780511763229.023
Available formats
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Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

  • Peribiliary cysts
  • Fergus V. Coakley, University of California, San Francisco
  • Book: Pearls and Pitfalls in Abdominal Imaging
  • Online publication: 05 November 2011
  • Chapter DOI: https://doi.org/10.1017/CBO9780511763229.023
Available formats
×