July 6, 2009

Choledochal Cyst

Fig.1: Transverse ultrasound image at the region of the gallbladder (arrow) shows a nearby large cystic structure (star).
Fig. 2 and 3: Axial T2 MR image and MRCP confirms the presence of the large cystic lesion adjacent to the gallbladder (arrow), proven to be saccular dilatation of the extrahepatic bile duct.

Fig.4: Diagram showing Todani classification of choledochal cyst

Choledochal Cyst
  • Rare, congenital dilatation of biliary tree
  • Can be either intra-hepatic, extra-hepatic or both
  • Female:male ratio = 4:1, more common in Asia
  • At risk for recurrent cholangitis, stricture, stone, pancreatitis and malignancy
  • Risk of malignant transformation increases with age, and more often in type I and IV cysts.
Todani Classification
  1. Type I - fusiform dilatation of extrahepatic duct
  2. Type II - focal saccular dilatation or diverticulum of extrahepatic duct
  3. Type III - cystic dilatation of bile duct confined to duodenal wall (choledochocele)
  4. Type IVa - combined intra and extrahepatic duct dilatation
  5. Type IVb - multiple extrahepatic duct dilatation
  6. Type V - multiple intrahepatic biliary cysts (Caroli's disease)
Our case - Todani type II choledochal cyst

1. Wiseman K, Buczkowski AK, Chung SW, et al. Epidemiology, presentation, diagnosis, and outcomes of choledochal cysts in adults in an urban environment. Am J Surg 2005;189:527-531.

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