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Mirza H, Besse W, Somlo S, Weinreb J, Kenney B, Jain D. An update on ductal plate malformations and fibropolycystic diseases of the liver. Hum Pathol 2023; 132:102-113. [PMID: 35777701 DOI: 10.1016/j.humpath.2022.06.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 06/22/2022] [Indexed: 02/07/2023]
Abstract
A variety of cystic and fibrocystic lesions can occur in the liver, which may be single or multiple and etiologically can be acquired or have genetic underpinnings. Although the morphology of ductal plate development and various associated malformations has been well described, the genetic etiologies of many of these disorders are still poorly understood. Multiple clinical phenotypes in the liver are proposed to originate from ductal plate malformations: congenital hepatic fibrosis, Caroli's disease, Von Meyenburg complex, and the liver cysts of autosomal dominant polycystic kidney and liver diseases. Although many of the patients with these disorders, particularly with isolated liver involvement remain asymptomatic, some develop portal hypertension or symptoms from cyst enlargement. Development of hepatocellular malignancy is a risk in a small subset. Recent advances have made it now possible for some of these phenotypes to be genetically defined, and intriguingly animal models of adult polycystic liver disease suggest that abnormal organ development is not required. This review describes the current understanding, genetic underpinning, and key clinicopathologic and imaging features of these fibropolycystic liver diseases.
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Affiliation(s)
- Haris Mirza
- Department of Pathology, Yale School of Medicine, New Haven CT 06520, USA
| | - Whitney Besse
- Department of Internal Medicine (Section of Nephrology), Yale School of Medicine, New Haven CT 06520, USA
| | - Stefan Somlo
- Department of Internal Medicine (Section of Nephrology), Yale School of Medicine, New Haven CT 06520, USA; Department of Genetics, Yale School of Medicine, New Haven CT 06520, USA
| | - Jeffrey Weinreb
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven CT 06520, USA
| | - Barton Kenney
- Department of Pathology, Middlesex Health, Middletown CT 06457, USA
| | - Dhanpat Jain
- Department of Pathology, Yale School of Medicine, New Haven CT 06520, USA.
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2
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Muntean A, Davenport M. Biliary atresia & choledochal malformation--Embryological and anatomical considerations. Semin Pediatr Surg 2022; 31:151235. [PMID: 36442454 DOI: 10.1016/j.sempedsurg.2022.151235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The two main biliary pathologies in paediatric practice, biliary atresia and choledochal malformations (CM), have their origins within prenatal life. Nevertheless, the actual mechanisms remain elusive with many unanswered questions. The extrahepatic bile duct develops as a funnel-like structure emerging from the foregut from about 3-4 weeks of gestation into the mesenchyme of the septum transversum. The cranial elements of this contain hepatoblasts - the precursors to the two key cell lines that will become hepatocytes and biliary epithelial cells. The intrahepatic bile ducts develop separately and emerge from a complex process involving the ductal plate surrounding the in-growing portal venous system from about the 7-8th week of gestation. A developmental defect at some point(s) in this process may be the cause of at least some variants of BA - the Biliary Atresia Splenic Malformation syndrome particularly - though evidence in the more common isolated BA is much more circumstantial. Similarly, some types of choledochal malformation, specifically the cystic type of CM, are invariably present during prenatal life although again an actual aetiological mechanism remains elusive.
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Affiliation(s)
- Ancuta Muntean
- Deptartment of Paediatric Surgery, Kings College Hospital, London
| | - Mark Davenport
- Deptartment of Paediatric Surgery, Kings College Hospital, London.
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3
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Chenin M, Paisant A, Lebigot J, Bazeries P, Debbi K, Ronot M, Laurent V, Aubé C. Cystic liver lesions: a pictorial review. Insights Imaging 2022; 13:116. [PMID: 35838923 PMCID: PMC9287528 DOI: 10.1186/s13244-022-01242-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 05/24/2022] [Indexed: 11/10/2022] Open
Abstract
Hepatic cysts (HC) are sac-like structures mainly filled with liquid and showing a distinct membrane. They are usually found incidentally through imaging. A wide spectrum of imaging patterns may be observed for common and uncommon, neoplastic and non-neoplastic diseases. While simple hepatic cysts occur frequently and do not require any treatment or follow-up, non-typical cysts should be carefully analysed to avoid misdiagnosing a lesion that would require appropriate management. Therefore, adequate knowledge of all the relevant imaging patterns is critical to secure an accurate diagnosis. The aim of this review is to describe the imaging features of the different types of hepatic cysts.
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Affiliation(s)
- Mégane Chenin
- Department of Radiology, University Hospital of Angers, 4 rue Larrey, 49 933, Angers Cedex 09, France.
| | - Anita Paisant
- Department of Radiology, University Hospital of Angers, 4 rue Larrey, 49 933, Angers Cedex 09, France.,HIFIH Laboratory, EA 3859, UNIV Angers, 49045, Angers, France
| | - Jérôme Lebigot
- Department of Radiology, University Hospital of Angers, 4 rue Larrey, 49 933, Angers Cedex 09, France.,HIFIH Laboratory, EA 3859, UNIV Angers, 49045, Angers, France
| | - Paul Bazeries
- Department of Radiology, University Hospital of Angers, 4 rue Larrey, 49 933, Angers Cedex 09, France
| | - Kawtar Debbi
- Department of Radiology, La Timone Children Hospital of Marseille, 264 rue St Pierre, 13385, Marseille Cedex 05, France
| | - Maxime Ronot
- Department of Radiology, Beaujon Hospital, APHP.Nord, 100 boulevard du Général Leclerc, 92110, Clichy, France.,Université de Paris, Paris, France
| | - Valérie Laurent
- Department of Radiology, University Hospital of Nancy, 29 avenue du Maréchal de Lattre de Tassigny, 54035, Nancy, France
| | - Christophe Aubé
- Department of Radiology, University Hospital of Angers, 4 rue Larrey, 49 933, Angers Cedex 09, France.,HIFIH Laboratory, EA 3859, UNIV Angers, 49045, Angers, France
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4
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Riedesel EL, Richer EJ, Taylor SD, Tao T, Gagnon MH, Braithwaite KA, Alazraki AL, Khanna G. Pediatric Hepatic Cystic Lesions: Differential Diagnosis and Multimodality Imaging Approach. Radiographics 2022; 42:1514-1531. [PMID: 35839138 DOI: 10.1148/rg.220006] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
When a pediatric hepatic cystic lesion is identified at imaging, the differential diagnosis may be broad, including developmental, infectious, neoplastic, and posttraumatic or iatrogenic causes. The location of a cystic lesion and its number, size, composition, and relationship to the biliary system are features that help in narrowing the differential diagnosis. An incidentally detected simple hepatic cyst is the most commonly encountered. Ciliated foregut cysts are typically located in hepatic segment IVa. The presence of multiple cysts should raise suspicion for fibropolycystic liver disease, a group of related lesions-including biliary hamartoma and choledochal cyst-caused by abnormal embryologic development of the ductal plate. Communication of the cystic lesion with the biliary tree can confirm the diagnosis of choledochal cyst. In a neonate with jaundice, a cystic lesion at the porta hepatis should raise suspicion for choledochal cyst versus cystic biliary atresia. Hepatic abscess can appear cystlike, though typically with internal contents. In an immunocompromised child, multiple cystlike lesions should raise concern for fungal microabscesses. A complex cystic mass in a young child should raise suspicion for mesenchymal hamartoma, which can evolve into undifferentiated embryonal sarcoma if untreated. Hepatic hematoma and biloma can appear cystlike in children with a history of trauma or recent intervention. In neonates with an umbilical vein catheter (UVC), an intrahepatic cyst along the course of the UVC should raise concern for infusate extravasation. Familiarity with imaging findings and clinical features is essential for achieving accurate diagnosis of pediatric hepatic cystic lesions, which in turn can guide appropriate clinical management. Online supplemental material is available for this article. ©RSNA, 2022.
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Affiliation(s)
- Erica L Riedesel
- From the Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (E.L.R., E.J.R., S.D.T., M.H.G., K.A.B., A.L.A., G.K.); Department of Radiology, Children's Healthcare of Atlanta, 1405 Clifton Road NE, Atlanta, GA 30322 (E.L.R., E.J.R., S.D.T., K.A.B., A.L.A., G.K.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (T.T.)
| | - Edward J Richer
- From the Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (E.L.R., E.J.R., S.D.T., M.H.G., K.A.B., A.L.A., G.K.); Department of Radiology, Children's Healthcare of Atlanta, 1405 Clifton Road NE, Atlanta, GA 30322 (E.L.R., E.J.R., S.D.T., K.A.B., A.L.A., G.K.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (T.T.)
| | - Susan D Taylor
- From the Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (E.L.R., E.J.R., S.D.T., M.H.G., K.A.B., A.L.A., G.K.); Department of Radiology, Children's Healthcare of Atlanta, 1405 Clifton Road NE, Atlanta, GA 30322 (E.L.R., E.J.R., S.D.T., K.A.B., A.L.A., G.K.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (T.T.)
| | - Ting Tao
- From the Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (E.L.R., E.J.R., S.D.T., M.H.G., K.A.B., A.L.A., G.K.); Department of Radiology, Children's Healthcare of Atlanta, 1405 Clifton Road NE, Atlanta, GA 30322 (E.L.R., E.J.R., S.D.T., K.A.B., A.L.A., G.K.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (T.T.)
| | - Marie-Helene Gagnon
- From the Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (E.L.R., E.J.R., S.D.T., M.H.G., K.A.B., A.L.A., G.K.); Department of Radiology, Children's Healthcare of Atlanta, 1405 Clifton Road NE, Atlanta, GA 30322 (E.L.R., E.J.R., S.D.T., K.A.B., A.L.A., G.K.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (T.T.)
| | - Kiery A Braithwaite
- From the Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (E.L.R., E.J.R., S.D.T., M.H.G., K.A.B., A.L.A., G.K.); Department of Radiology, Children's Healthcare of Atlanta, 1405 Clifton Road NE, Atlanta, GA 30322 (E.L.R., E.J.R., S.D.T., K.A.B., A.L.A., G.K.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (T.T.)
| | - Adina L Alazraki
- From the Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (E.L.R., E.J.R., S.D.T., M.H.G., K.A.B., A.L.A., G.K.); Department of Radiology, Children's Healthcare of Atlanta, 1405 Clifton Road NE, Atlanta, GA 30322 (E.L.R., E.J.R., S.D.T., K.A.B., A.L.A., G.K.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (T.T.)
| | - Geetika Khanna
- From the Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (E.L.R., E.J.R., S.D.T., M.H.G., K.A.B., A.L.A., G.K.); Department of Radiology, Children's Healthcare of Atlanta, 1405 Clifton Road NE, Atlanta, GA 30322 (E.L.R., E.J.R., S.D.T., K.A.B., A.L.A., G.K.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (T.T.)
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5
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Hepatic Cysts: Reappraisal of the Classification, Terminology, Differential Diagnosis, and Clinicopathologic Characteristics in 258 Cases. Am J Surg Pathol 2022; 46:1219-1233. [PMID: 35778790 DOI: 10.1097/pas.0000000000001930] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The literature on liver cysts is highly conflicting, mostly owing to definitional variations. Two hundred and fifty-eight ≥1 cm cysts evaluated pathologically using updated criteria were classifiable as: I. Ductal plate malformation related (63%); that is, cystic bile duct hamartoma or not otherwise specified-type benign biliary cyst (35 with polycystic liver disease). These were female predominant (F/M=2.4), large (10 cm), often multifocal with degenerative/inflammatory changes and frequently misclassified as "hepatobiliary cystadenoma." II. Neoplastic (13%); 27 (10.5%) had ovarian-type stroma (OTS) and qualified as mucinous cystic neoplasm (MCN) per World Health Organization (WHO). These were female, solitary, mean age 52, mean size 11 cm, and 2 were associated with carcinoma (1 in situ and 1 microinvasive). There were 3 intraductal papillary neoplasms, 1 intraductal oncocytic papillary neoplasm, 1 cystic cholangiocarcinoma, and 2 cystic metastasis. III. Infectious/inflammatory (12%). These included 23 hydatid cysts (including 2 Echinococcus alveolaris both misdiagnosed preoperatively as cancer), nonspecific inflammatory cysts (abscesses, inflammatory cysts: 3.4%). IV. Congenital (7%). Mostly small (<3 cm); choledochal cyst (5%), foregut cyst (2%). V. Miscellaneous (4%). In conclusion, hepatic cysts occur predominantly in women (3/1), are mostly (90%) non-neoplastic, and seldom (<2%) malignant. Cystic bile duct hamartomas and their relative not otherwise specified-type benign biliary cysts are frequently multifocal and often misdiagnosed as "cystadenoma/carcinoma." Defined by OTS, MCNs (the true "hepatobiliary cystadenoma/carcinoma") are solitary, constitute only 10.5% of hepatic cysts, and have a significantly different profile than the impression in the literature in that essentially all are perimenopausal females, and rarely associated with carcinoma (7%). Since MCNs can only be diagnosed by demonstration of OTS through complete microscopic examination, it is advisable to avoid the term "cystadenoma/cystadenocarcinoma" solely based on radiologic examination, and the following simplified terminology would be preferable in preoperative evaluation to avoid conflicts with the final pathologic diagnosis: (1) noncomplex (favor benign), (2) complex (in 3 subsets, as favor benign, cannot rule out malignancy, or favor malignancy), (3) malignant features.
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6
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Sharbidre K, Zahid M, Venkatesh SK, Bhati C, Lalwani N. Imaging of fibropolycystic liver disease. Abdom Radiol (NY) 2022; 47:2356-2370. [PMID: 35670875 DOI: 10.1007/s00261-022-03565-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/14/2022] [Accepted: 05/17/2022] [Indexed: 11/01/2022]
Abstract
Fibropolycystic liver diseases (FLDs) make up a rare spectrum of heritable hepatobiliary diseases resulting from congenital ductal plate malformations (DPMs) due to the dysfunction of proteins expressed on the primary cilia of cholangiocytes. The embryonic development of the ductal plate is key to understanding this spectrum of diseases. In particular, DPMs can result in various degrees of intrahepatic duct involvement and a wide spectrum of cholangiopathies, including congenital hepatic fibrosis, Caroli disease, polycystic liver disease, and Von Meyenberg complexes. The most common clinical manifestations of FLDs are portal hypertension, cholestasis, cholangitis, and (in rare cases) cholangiocarcinoma. This article reviews recent updates in the pathophysiology, imaging, and clinical management of FLDs.
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Affiliation(s)
- Kedar Sharbidre
- Department of Abdominal Imaging, University of Alabama at Birmingham, Birmingham, AB, USA.
| | - Mohd Zahid
- Department of Abdominal Imaging, University of Alabama at Birmingham, Birmingham, AB, USA
| | | | - Chandra Bhati
- Department of Transplant Surgery, University of Maryland Medical Center, Baltimore, ML, USA
| | - Neeraj Lalwani
- Department of Abdominal Imaging, Virginia Commonwealth University, Richmond, VA, USA
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7
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Hepatic manifestations of systemic disease: an imaging-based review. Pediatr Radiol 2022; 52:852-864. [PMID: 34797394 DOI: 10.1007/s00247-021-05222-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 08/28/2021] [Accepted: 10/05/2021] [Indexed: 10/19/2022]
Abstract
The liver is responsible for many processes that maintain human metabolic homeostasis and can be affected by several pediatric systemic diseases. In this manuscript, we explore key pathological findings and imaging features across multiple modalities of a spectrum of congenital, metabolic and autoimmune disorders. Strengthening the radiologists' knowledge regarding potential hepatic manifestations of these systemic diseases will ultimately lead to improved care for pediatric patients.
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8
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Shehi E, Fortuzi K, Ghazanfar H, Mehershahi S, Balar B. Apixaban Causing Hepatic Cystic Bleeding: A Rare but a Life-Threatening Complication. Case Rep Gastroenterol 2021; 15:904-909. [PMID: 34720842 PMCID: PMC8543326 DOI: 10.1159/000519276] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 08/20/2021] [Indexed: 01/11/2023] Open
Abstract
Cystic lesions of the liver are a heterogeneous group of disorders with varied etiology, prevalence, and clinical manifestations. Fibropolycystic liver disease encompasses a spectrum of related liver and biliary tract lesions caused by abnormal embryologic development of the ductal plates. These disorders include congenital hepatic fibrosis, biliary hamartomas, polycystic liver disease (PCLD), choledochal cysts, and Carolis disease. PCLD is arbitrarily defined as a liver that contains >20 cysts. Most liver cysts are incidentally found on imaging studies, and the majority of the patients with liver cysts are asymptomatic. Rarely, complications such as compression, infection, and bleeding within the cyst can occur. Under the effect of the increased pressure, the epithelial lining of the cyst undergoes necrosis and sloughing, causing injury of the fragile blood vessels, leading to intracystic bleeding. The bleeding within or from the cyst can be precipitated by anticoagulation. We present a patient with PCLD who developed intracystic bleeding after he was started on apixaban for the prevention of thromboembolism.
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Affiliation(s)
- Elona Shehi
- Division of Gastroenterology, Department of Medicine, Bronxcare Health System, Affiliated with Icahn School of Medicine at Mt. Sinai, Bronx, New York, USA
| | - Ked Fortuzi
- Department of Medicine, Bronxcare Health System, Affiliated with Icahn School of Medicine at Mt. Sinai, Bronx, New York, USA
| | - Haider Ghazanfar
- Department of Medicine, Bronxcare Health System, Affiliated with Icahn School of Medicine at Mt. Sinai, Bronx, New York, USA
| | - Shehriyar Mehershahi
- Division of Gastroenterology, Department of Medicine, Bronxcare Health System, Affiliated with Icahn School of Medicine at Mt. Sinai, Bronx, New York, USA
| | - Bhavna Balar
- Division of Gastroenterology, Department of Medicine, Bronxcare Health System, Affiliated with Icahn School of Medicine at Mt. Sinai, Bronx, New York, USA
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Diamond T, Nema N, Wen J. Hepatic Ciliopathy Syndromes. Clin Liver Dis (Hoboken) 2021; 18:193-197. [PMID: 34745577 PMCID: PMC8549716 DOI: 10.1002/cld.1114] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/12/2021] [Accepted: 03/13/2021] [Indexed: 02/04/2023] Open
Abstract
Content available: Author Interview and Audio Recording.
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Affiliation(s)
- Tamir Diamond
- Division of Gastroenterology, Hepatology and NutritionChildren's Hospital of PhiladelphiaPhiladelphiaPA
| | - Noor Nema
- Division of Gastroenterology, Hepatology and NutritionChildren's Hospital of PhiladelphiaPhiladelphiaPA
| | - Jessica Wen
- Division of Gastroenterology, Hepatology and NutritionChildren's Hospital of PhiladelphiaPhiladelphiaPA
- Department of PediatricsPerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPA
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JNK signaling prevents biliary cyst formation through a CASPASE-8-dependent function of RIPK1 during aging. Proc Natl Acad Sci U S A 2021; 118:2007194118. [PMID: 33798093 PMCID: PMC8000530 DOI: 10.1073/pnas.2007194118] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
JNK signaling has been studied intensively in models of liver physiology and disease, but previous studies had focused on young mice. However, it had not been recognized that JNK plays a fundamental role in maintaining liver homeostasis and preventing the formation of biliary cysts in aging mice. These observations call for caution in all long-term pharmacological inhibition strategies targeting the JNK pathway. Finally, our results provide evidence of a molecular link between JNK and the cell-death mediator RIPK1. The specific overexpression of RIPK1 in cysts of a subset of patients with polycystic liver disease suggests that RIPK1 might be mechanistically involved in the pathogenesis of human biliary cysts. The c-Jun N-terminal kinase (JNK) signaling pathway mediates adaptation to stress signals and has been associated with cell death, cell proliferation, and malignant transformation in the liver. However, up to now, its function was experimentally studied mainly in young mice. By generating mice with combined conditional ablation of Jnk1 and Jnk2 in liver parenchymal cells (LPCs) (JNK1/2LPC-KO mice; KO, knockout), we unraveled a function of the JNK pathway in the regulation of liver homeostasis during aging. Aging JNK1/2LPC-KO mice spontaneously developed large biliary cysts that originated from the biliary cell compartment. Mechanistically, we could show that cyst formation in livers of JNK1/2LPC-KO mice was dependent on receptor-interacting protein kinase 1 (RIPK1), a known regulator of cell survival, apoptosis, and necroptosis. In line with this, we showed that RIPK1 was overexpressed in the human cyst epithelium of a subset of patients with polycystic liver disease. Collectively, these data reveal a functional interaction between JNK signaling and RIPK1 in age-related progressive cyst development. Thus, they provide a functional linkage between stress adaptation and programmed cell death (PCD) in the maintenance of liver homeostasis during aging.
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11
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Incidental Liver Findings on Cross-sectional Imaging. Radiol Clin North Am 2021; 59:569-590. [PMID: 34053606 DOI: 10.1016/j.rcl.2021.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Hepatic incidental findings often are seen on cross-sectional imaging examinations of the chest, spine, pelvis, or other nondedicated hepatic imaging. Radiologists are tasked with appropriately triaging, which requires further evaluation, even in the setting of an otherwise limited evaluation. This article reviews common benign entities encountered on ultrasound, computed tomography, or magnetic resonance imaging, along with their characteristic imaging features. Imaging features that are suspicious for malignancy or suggest the need for further evaluation also are discussed. Two algorithms are proposed to guide radiologists in their recommendations based on patient risk factors, focal hepatic abnormality size, and available imaging features.
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12
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Mamone G, Di Piazza A, Gentile G, Milazzo M, Carollo V, Crinò F, Marrone G, Caruso S, Sparacia G, Maruzzelli L, Miraglia R. Imaging of calcified hepatic lesions: spectrum of diseases. Abdom Radiol (NY) 2021; 46:2540-2555. [PMID: 33452900 DOI: 10.1007/s00261-020-02924-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 12/13/2020] [Accepted: 12/19/2020] [Indexed: 01/23/2023]
Abstract
Hepatic calcifications have been increasingly identified over the past decade due to the widespread use of high-resolution Computed Tomography (CT) imaging. Calcifications can be seen in a vast spectrum of common and uncommon diseases, from benign to malignant, including cystic lesions, solid neoplastic masses, and inflammatory focal lesions. The purpose of this paper is to present an updated review of CT imaging findings of a wide range of calcified hepatic focal lesions, which can help radiologists to narrow the differential diagnosis.
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Affiliation(s)
- Giuseppe Mamone
- Radiology Unit, Department of Diagnostic and Therapeutic Services, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), via Tricomi 5, 90127, Palermo, Italy.
| | - Ambra Di Piazza
- Radiology Unit, Department of Diagnostic and Therapeutic Services, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), via Tricomi 5, 90127, Palermo, Italy
| | - Giovanni Gentile
- Radiology Unit, Department of Diagnostic and Therapeutic Services, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), via Tricomi 5, 90127, Palermo, Italy
| | - Mariapina Milazzo
- Radiology Unit, Department of Diagnostic and Therapeutic Services, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), via Tricomi 5, 90127, Palermo, Italy
| | - Vincenzo Carollo
- Radiology Unit, Department of Diagnostic and Therapeutic Services, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), via Tricomi 5, 90127, Palermo, Italy
| | - Francesca Crinò
- Radiology Unit, Department of Diagnostic and Therapeutic Services, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), via Tricomi 5, 90127, Palermo, Italy
| | - Gianluca Marrone
- Radiology Unit, Department of Diagnostic and Therapeutic Services, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), via Tricomi 5, 90127, Palermo, Italy
| | - Settimo Caruso
- Radiology Unit, Department of Diagnostic and Therapeutic Services, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), via Tricomi 5, 90127, Palermo, Italy
| | - Gianvincenzo Sparacia
- Radiology Unit, Department of Diagnostic and Therapeutic Services, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), via Tricomi 5, 90127, Palermo, Italy
| | - Luigi Maruzzelli
- Radiology Unit, Department of Diagnostic and Therapeutic Services, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), via Tricomi 5, 90127, Palermo, Italy
| | - Roberto Miraglia
- Radiology Unit, Department of Diagnostic and Therapeutic Services, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), via Tricomi 5, 90127, Palermo, Italy
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13
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Yao X, Ao W, Fang J, Mao G, Chen C, Yu L, Cai H, Xu C. Imaging manifestations of Caroli disease with autosomal recessive polycystic kidney disease: a case report and literature review. BMC Pregnancy Childbirth 2021; 21:294. [PMID: 33845788 PMCID: PMC8042699 DOI: 10.1186/s12884-021-03768-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 03/30/2021] [Indexed: 12/22/2022] Open
Abstract
Background Both Caroli disease (CD) and autosomal recessive polycystic kidney disease (ARPKD) are autosomal recessive disorders, which are more commonly found in infants and children, for whom surviving to adulthood is rare. Early diagnosis and intervention can improve the survival rate to some extent. This study adopted the case of a 26-year-old pregnant woman to explore the clinical and imaging manifestations and progress of CD concomitant with ARPKD to enable a better understanding of the disease. Case presentation A 26-year-old pregnant woman was admitted to our hospital for more than 2 months following the discovery of pancytopenia and increased creatinine. Ultrasonography detected an enlarged left liver lobe, widened hepatic portal vein, splenomegaly, and dilated splenic vein. In addition, both kidneys were obviously enlarged and sonolucent areas of varying sizes were visible, but color Doppler flow imaging revealed no abnormal blood flow signals. The gestational age was approximately 25 weeks, which was consistent with the actual fetal age. Polyhydramnios was detected but no other abnormalities were identified. Magnetic resonance imaging revealed that the liver was plump, and polycystic liver disease was observed near the top of the diaphragm. The T1 and T2 weighted images were the low and high signals, respectively. The bile duct was slightly dilated; the portal vein was widened; and the spleen volume was enlarged. Moreover, the volume of both kidneys had increased to an abnormal shape, with multiple, long, roundish T1 and T2 abnormal signals being observed. Magnetic resonance cholangiopancreatography revealed that intrahepatic cystic lesions were connected with intrahepatic bile ducts. The patient underwent a genetic testing, the result showed she carried two heterozygous mutations in PKHD1. The patient was finally diagnosed with CD with concomitant ARPKD. The baby underwent a genetic test three months after birth, the result showed that the patient carried one heterozygous mutations in PKHD1, which indicated the baby was a PKHD1 carrier. Conclusions This case demonstrates that imaging examinations are of great significance for the diagnosis and evaluation of CD with concomitant ARPKD.
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Affiliation(s)
- Xiuzhen Yao
- Department of Ultrasound, Shanghai Putuo District People's Hospital, Shanghai, China
| | - Weiqun Ao
- Department of Radiology, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Jianhua Fang
- Department of Ultrasound, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Guoqun Mao
- Department of Radiology, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Chuanghua Chen
- Department of Ultrasound, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Lifang Yu
- Department of Ultrasound, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Huaijie Cai
- Department of Ultrasound, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Chenke Xu
- Department of Ultrasound, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
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Abstract
Congenital and hereditary cystic lesions of the abdomen are relatively rare. Correct diagnosis is critical as they may simulate several other benign and malignant acquired diseases of the abdomen. With the correct and appropriate use of imaging, diagnosis may be relatively straightforward and clinical management may be implemented appropriately. The purpose of this article is to describe imaging findings of common and uncommon congenital and hereditary cystic disease of the abdominal organs.
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Li QQ, Guo XZ, Li HY, Qi XS. Portal hypertension in a patient with biliary hamartomas: A case report. World J Clin Cases 2020; 8:1745-1751. [PMID: 32420308 PMCID: PMC7211530 DOI: 10.12998/wjcc.v8.i9.1745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 03/26/2020] [Accepted: 04/16/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Biliary hamartomas (BH) are a rare benign disease caused by malformation of the intrahepatic bile ducts. BH are occasionally diagnosed, but often lack obvious clinical symptoms. They are usually diagnosed by biopsy and imaging tests in clinical practice. Few studies have reported the association of BH with portal hypertension.
CASE SUMMARY A 40-year-old man was repeatedly admitted to our hospital due to hematochezia. The source of bleeding was considered to be gastroesophageal varices and portal hypertensive gastropathy by endoscopy. He had no history of hepatitis virus infection, alcohol abuse, drug-induced liver injury, or autoimmune liver disease. He underwent magnetic resonance imaging, which showed rounded, irregular, low-signal-T1 and high-signal-T2 lesions diffusely distributed on the liver, that were not communicated with the biliary system on magnetic resonance cholangiopancreatography. According to the imaging examination, the patient was considered to have a diagnosis of BH with portal hypertension.
CONCLUSION Based on the present case report, BH may be a potential etiology of portal hypertension.
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Affiliation(s)
- Qian-Qian Li
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China
- Postgraduate College, Dalian Medical University, Dalian 116044, Liaoning Province, China
| | - Xiao-Zhong Guo
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China
| | - Hong-Yu Li
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China
| | - Xing-Shun Qi
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China
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