Cystic duct cyst in adults: a systematic review of the sixth entity

Imaging of Biliary Tree Abnormalities

Pathologic conditions of the biliary system, although common, can be difficult to diagnose clinically. Challenges in biliary imaging include anatomic variants and the dynamic nature of the biliary tract, which can change with age and intervention, blurring the boundaries of normal and abnormal. Choledochal cysts can have numerous appearances and are important to diagnose given the risk of cholangiocarcinoma potentially requiring surgical resection. Choledocholithiasis, the most common cause of biliary dilatation, can be difficult to detect at US and CT, with MRI having the highest sensitivity. However, knowledge of the imaging pitfalls of MRI and MR cholangiopancreatography is crucial to avoid misinterpretation. Newer concepts in biliary tract malignancy include intraductal papillary biliary neoplasms that may develop into cholangiocarcinoma. New paradigms in the classification of cholangiocarcinoma correspond to the wide range of imaging appearances of the disease and have implications for prognosis. Accurately staging cholangiocarcinoma is imperative, given expanding curative options including transplant and more aggressive surgical options. Infections of the biliary tree include acute cholangitis or recurrent pyogenic cholangitis, characterized by obstruction, strictures, and central biliary dilatation. Inflammatory conditions include primary sclerosing cholangitis, which features strictures and fibrosis but can be difficult to differentiate from secondary causes of sclerosing cholangitis, including more recently described entities such as immunoglobulin G4-related sclerosing cholangitis and COVID-19 secondary sclerosing cholangitis. The authors describe a wide variety of benign and malignant biliary tract abnormalities, highlight differentiating features of the cholangitides, provide an approach to interpretation based on the pattern of imaging findings, and discuss pearls and pitfalls of imaging to facilitate accurate diagnosis. ©RSNA, 2024 Supplemental material is available for this article.

The Initial Experience of Laparoscopic Management for Type VI Choledochal Cyst in Children

Purposes: Dilatation of cystic duct is very rare and had been classified as Todani type VI choledochal cyst. Choledochal cyst combined with dilatation of cystic duct is difficult to diagnose preoperatively. The purpose of this study is to report the rare variants and discuss the significance and laparoscopic management strategy in children. Methods: The subjects for this study were 10 consecutive patients with type VI choledochal cyst who had laparoscopic procedures at our institute between January 2009 and January 2023. Laparoscopic cholecystectomy, excision of the dilated cystic duct, and choledochal cyst were carried out, and the continuity of the biliary duct was re-established through a Roux-en-Y hepaticojejunostomy. Results: Cystic duct combined with the common bile duct dilatation was revealed in all the patients intraoperatively. Laparoscopic procedures were completed with no conversions. The postoperative recovery was uneventful. The mean follow-up duration was 27 ± 12.7 months (range 5-36 months) with no postoperative complications encountered. Conclusions: The rare entity of type VI choledochal cyst should be recognized as a distinct type of choledochal cyst and need to be given enough attention clinically. The laparoscopic procedure is a feasible option for experienced surgeons.

A new variant of Choledochal cyst-type VI: a rare case presentation and review of the literature

A 53-year-old male patient with a previous diagnosis of dilatation of the common bile duct was admitted to the hospital due to recurrent episodes of vague epigastric pain over a 4-month period. After undergoing abdominal CT, MRI, MRCP, ERCP examinations, together with joint diagnosis by the radiology department and the gastroscopy unit, the diagnosis of a cystic dilatation of the common bile duct was excluded, and to preliminarily diagnose as cystic lesion at the hepatoduodenum ligament. A nasobiliary tube was preset before the surgery, and it was found that the gallbladder, the cyst, and the common bile duct were connected in sequence during the surgery, leading to the definitive diagnosis of biliary cyst of the cystic duct. During the surgery, the anatomical position of the common bile duct was accurately identified, avoiding iatrogenic biliary injury and preserving the integrity of the common bile duct structure. The patient recovered and was discharged from the hospital on the 14th postoperative day. Cystic duct cysts are a relatively new and rare condition. This case demonstrates that clinical decision-making by a multidisciplinary team is of great significance for such diseases, and preoperative assessment of the anatomical relationship between cystic dilation lesions in the hepatic portal region and the biliary system and gallbladder is also crucial.