Diagnostic Ultrasound - Abdomen and Pelvis

Biliary Hamartoma
Diagnoses: Liver
TERMINOLOGY
• Benign malformations of biliary tract
• Synonyms: von Meyenburg complex, bile duct hamartoma
IMAGING
• Ultrasound
○ Grayscale ultrasound
– Numerous small, hypoechoic or hyperechoic foci
uniformly distributed throughout liver
□ Leads to inhomogeneous and coarse appearance of
liver echotexture
– Multiple echogenic foci, often with associated "comet
tail" artifacts
– Typically smaller lesions appear as echogenic foci
whereas larger lesions appear cystic
□ Often extent of echogenic foci on ultrasound is
greater than anticipated, based on comparison CT
or MR
○ Color Doppler ultrasound
KEY FACTS
– Twinkling artifact may be seen
• MRCP
○ Numerous scattered, tiny cysts without communication
between lesions and biliary tree
TOP DIFFERENTIAL DIAGNOSES
• Multiple simple hepatic cysts
• Multiple small hepatic metastasis
• Hepatic microabscesses
• Autosomal dominant polycystic liver disease
• Caroli disease
CLINICAL ISSUES
• May be misdiagnosed as multiple hepatic metastasis,
microabscesses, cirrhosis, lymphoma, leukemia, etc. at initial
imaging
• No further evaluation necessary when seen as isolated
finding in healthy, nononcologic patient
(Left) Grayscale ultrasound of
liver with numerous biliary
hamartomas shows diffuse
inhomogeneous and coarse
parenchymal echotexture with
numerous small, hypoechoic
ſt and hyperechoic st foci.
Note some echogenic foci
have associated "comet tail"
artifacts . (Right) Grayscale
ultrasound of the liver shows
diffuse, coarse, parenchymal
echotexture with multiple
echogenic foci, some with
associated "comet tail"
artifacts ſt generated from
the biliary hamartomas.
(Left) Grayscale ultrasound of
the liver in a patient with
multiple biliary hamartomas
as evidenced by multiple tiny
echogenic foci, some of which
are associated with "comet
tail" artifacts st. (Right)
Grayscale ultrasound of liver
shows heterogeneous
echotexture of liver
parenchyma due to numerous
tiny, hypoechoic nodules ſt
representing biliary
hamartomas. Note several
"comet tail" artifacts
emanating from several of the
hamartomas .
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