59 year old male – on routine health check with no active complaints. No jaundice or abdominal distension or pain or GI bleed.
- 59 year old male – on routine health check with no active complaints. No jaundice or abdominal distension or pain or GI bleed.
- LFT – Normal. Fibroscan of liver - early liver fibrosis.
- A & B: USG demonstrates altered heterogeneous hepatic echotexture with multiple echogenic foci and small cysts.
- C&D: Coronal and axial T2
- E : Axial STIR
- Multiple irregular shaped small varying sized hyperintense cystic scattered in both lobes of liver.
- No communication of the cysts with the bile ducts.
BILIARY HAMARTOMAS
- Rare cause of multiple benign hepatic lesions.
- AKA von Meyenburg complexes / multiple bile duct hamartomas.
- More common in women (3x) than men.
- Associated with:
- ADPKD
- ARPKD
- Polycystic liver disease
- Risk of possible malignant transformation of biliary hamartomas into cholangiocarcinoma and hepatocellular carcinoma.
Radiographic features
- Multiple small round or irregular lesions throughout the liver.
- Usually ~5-30 mm at imaging.
- USG:
- Small hamartomas are usually echogenic.
- Larger hamartomas (>10 mm) may appear hypoechoic or anechoic and comet-tail artifact may be seen.
- CT: Hypodense and often show no enhancement.
- MRI: Cystic without enhancement.
DDX
Multiple liver metastases (more variable size and prominent enhancement), Multiple liver microabscesses (clinical context is important, may have diffusion restriction on MRI), Multiple small hepatic cysts (uniform rounded shape).
References
- Mortelé KJ, Ros PR. Cystic focal liver lesions in the adult: differential CT and MR imaging features. Radiographics 2001; 21:895-910.
- Borhani AA, et al. Cystic Hepatic Lesions: A Review and an Algorithmic Approach. Am J Roentgenol. 2014;203: 1192-1204. 10.2214/AJR.13.12386
- Vachha B, et al. Cystic lesions of the liver. AJR Am J Roentgenol. 2011 Apr;196(4):W355-66.
- Chung EB. Multiple bile-duct hamartomas. Cancer. 1970;26 (2): 287-96. - Pubmed citation
- Tohmé-noun C, Cazals D, Noun R et-al. Multiple biliary hamartomas: magnetic resonance features with histopathologic correlation. Eur Radiol. 2008;18 (3): 493-9. doi:10.1007/s00330-007-0790-z - Pubmed citation
- Karhunen PJ. Adult polycystic liver disease and biliary microhamartomas (von Meyenburg's complexes). Acta Pathol Microbiol Immunol Scand A. 1986;94 (6): 397-400
Dr. Vikhyath Shetty
Consultant Radiologist – Manipal Hospitals Radiology Group
MBBS, MD, DNB
Dr. K Vishnu Vardhan Reddy
Fellow In Cross Sectional Imaging
Manipal hospital , Yeshwanthpur, Bengaluru
