Biliary Pathology

Question 1

What is a choledochal cyst?

Answer 1

a congenital, focal, or diffuse cystic dilation of the biliary tree

Question 2

what are the risk factors of a choledochal cyst?

Answer 2

• more common in men
• increased incidents in infants
• associated with gallstones, pancreatitis, and cirrhosis

Question 3

what are the symptoms of a choledochal cyst?

Answer 3

• abdominal mass
• pain
• fever
• jaundice

Question 4

sonographic appearance of a choledochal cyst

Answer 4

appear as cysts in an ultrasound
- anechoic
- echogenic walls
- posterior enhancement
- round

Question 5

define Caroli’s Disease

Answer 5

a rare congenital abnormality most likely inherited in an autosomal recessive fashion.

Question 6

what is Caroli’s Disease associated with?

Answer 6

characterized by congenital segmental saccular cystic dilation of major intrahepatic bile ducts
- usually found in young adults or pediatric patients
- renal disease
- congenital hepatic fibrosis

Question 7

symptoms of Caroli’s Disease

Answer 7

• recurrent cramplike upper abd pain
• secondary to biliary stasis
• ductal stones
• cholangitis
• hepatic fibrosis
• cystic disease of the kidneys (ADPKD)

Question 8

what is considered a dilated duct?

Answer 8

where the CHD has an internal diameter of greater than 4mm

Question 9

what is the most common cause of ductal dilation?

Answer 9

the presence of an obstruction like a tumor or thrombus within the ductal system

Question 10

how does ductal dilation appear on US?

Answer 10

it appears as the “shotgun” symbol on US when the intrahepatic ducts are dilated

Question 11

what can cause on obstruction of the distal CBD?

Answer 11

the most common cause is pancreatic carcinoma, choledocholithiasis, and chronic pancreatitis with stricture formation

Question 12

define cholangiocarcinoma

Answer 12

a rare malignancy that originates in the CBD or CHD.

Question 13

where is cholangiocarcinoma usually located?

Answer 13

in the CBD or CHD

Question 14

what is a specific type of cholangiocarcinoma that occurs in the CHD?

Answer 14

a Klatskin’s tumor is a specific type of cancer that occurs in the CHD.

Question 15

appearance of a Klatskin’s tumor

Answer 15

although the mass may not show up on ultrasound, a nonunion of the right and left hepatic ducts is a characteristic of a Klatskin’s tumor

Question 16

define Mirizzi syndrome

Answer 16

Mirizzi syndrome is an uncommon cause for extrahepatic biliary obstruction as a result of an impacted stone in the cystic duct

Question 17

what are the symptoms of Mirizzi syndrome?

Answer 17

painful jaundice

Question 18

how does Mirizzi syndrome appear on US?

Answer 18

an intrahepatic ductal dilation is seen with a normal size common duct and a large stone in the cystic duct or the neck of the gallbladder

Question 19

define choledocholithiasis

Answer 19

choledocholithiasis is the formation of calcium stones in the bile duct

Question 20

what may cause a primary ductal stone?

Answer 20

primary ductal stones may be caused from disease, causing strictures or dilation of the bile ducts leading to stasis

Question 21

what is a secondary ductal stone?

Answer 21

a secondary ductal stone denotes the majority of stones in the CBD have migrated from the GB and are usually associated with calculus cholecystitis

Question 22

define hemobilia

Answer 22

bleeding in or around the biliary tract

Question 23

what are the causes of hemobilia?

Answer 23

the main cause of hemobilia is trauma, secondary to percutaneous biliary procedures or liver biopsies

Question 24

clinical symptoms of hemobilia

Answer 24

• pain
• bleeding
• jaundice

Question 25

sonographic appearance of hemobilia

Answer 25

depends on how long the blood has been there - if it is an acute hemorrhage, it will appear as fluid with low-level internal echoes

Question 26

define pneumobilia

Answer 26

air within the biliary tree secondary to biliary intervention, biliary-enteric anastomoses, or CBD stents

Question 27

what may cause pneumobilia?

Answer 27

- Emphysematous cholecystitis - Inflammation from an impacted stone in the CBD - Prolonged acute cholecystitis, which may lead to erosion of the bowel

Question 28

sonographic appearance of pneumobilia

Answer 28

- The air in the bile ducts appears as bright, echogenic linear structures that follow the portal triads - The posterior dirty shadow and reverberation artifact are seen - Movement of tiny air bubbles with a change in the patient’s position should be noted

Question 29

define cholangitis

Answer 29

cholangitis is a serious infection in the bile ducts. this can occur when a stone blocks the normal passage of bile. this causes the fluid to back up, which can cause an infection to occur.

Question 30

symptoms of cholangitis

Answer 30

- malaise - fever - sweating - shivering - RUQ pain - jaundice in serious cases, patient is: - lethargic - prostrate - in shock - leukocytosis - elevation of serum alkaline phosphatase and bilirubin

Question 31

define cystadenoma

Answer 31

a rare intrahepatic biliary tumor

Question 32

define cystadenocarcinoma

Answer 32

a rare intrahepatic biliary tumor

Question 33

risk factors of cystadenoma and cystadenocarcinoma

Answer 33

more common in middle-aged women whose clinical presentation includes: - abd pain - abd mass - jaundice

Question 34

sonographic appearance of cystadenoma or cystadenocarcinoma

Answer 34

cystic mass with multiple septa and papillary excrescences

Question 35

define cholangiocarcinoma

Answer 35

cholangiocarcinoma is the second most common primary malignancy of the liver

Question 36

risk factors of cholangiocarcinoma

Answer 36

incidence of this tumor has risen, secondary to increasing number of patients with liver cirrhosis and hep C infection

Question 37

sonographic appearance of cholangiocarcinoma

Answer 37

- large hepatic mass - hypoechoic to hyperechoic - heterogenous texture

Question 38

what cancer spread to biliary tree?

Answer 38

the most common tumor sites that can spread to the biliary tree are from the breast, colon, or melanoma

Question 39

what is the sonographic appearance of metastases?

Answer 39

the sonographic appearance of metastases is similar to that of cholangiocarcinoma

Question 40

define hydrops

Answer 40

hydrops is a distended non-inflammatory GB due to obstruction of the cystic duct

Question 41

symptoms of hydrops

Answer 41

hydrops is asymptomatic and appears as a palpable mass

Question 42

sonographic appearance of hydrops

Answer 42

the GB appears enlarged and measures as larger than the normal size

Question 43

define Courvoisier's gallbladder

Answer 43

courvoisier's gallbladder is a malignancy in the head of the pancreas with a dilated CBD - symptoms include painless jaundice and RUQ palpable mass