Diagnostic Ultrasound - Abdomen and Pelvis

Peribiliary Cyst
Diagnoses: Liver
TERMINOLOGY
• Cystic dilatation of obstructed periductal glands of bile
ducts
• Retention cyst of peribiliary gland
IMAGING
• Well-defined, cystic structures adjacent to portal triads
• Usually multiple; discrete, round/oval/tubular or confluent
configuration
• Variable size, from 2 mm to 2 cm
• Smooth and thin walls without internal structures
• No enhancement of contents on CECT or MR
• Nonopacification with direct cholangiography
orhepatobiliary phase MR using hepatocyte specific
contrast agent
○ Due to lack of communication with biliary tree
TOP DIFFERENTIAL DIAGNOSES
• Biliary ductal dilatation
KEY FACTS
• Caroli disease
• Hepatic AD polycystic disease
• Periportal edema/inflammation
PATHOLOGY
• Disturbed portal venous flow, periductal fibrosis and
inflammation →obliteration of neck of peribiliary glands
→formation of retention cyst
• Associated with chronic hepatitis, cirrhosis, portal
hypertension, portal vein thrombosis, liver transplantation
CLINICAL ISSUES
• Peribiliary cysts are typically asymptomatic; symptoms
often related to underlying liver disease
• Obstructive jaundice may occur in end-stage liver cirrhosis
or as complication of post-liver transplantation
• May increase in size and number of cysts as cirrhosis
progresses
(Left) Grayscale ultrasound
shows numerous small
peribiliary cysts ſt clustered
in a linear configuration
located along the portal vein
. (Right) Color Doppler
ultrasound in the same patient
confirms the peribiliary cysts
ſt are located adjacent to the
portal vein . Peribiliary
cysts should not be confused
with biliary ductal dilatation,
which would have a more
tubular and continuous
appearance adjacent to the
portal vein.
(Left) Longitudinal grayscale
ultrasound shows numerous
clustered small peribiliary
cysts ſt coursing along the
hepatic hilum. (Right)
Transverse color Doppler
ultrasound shows small
peribiliary cysts ſt adjacent to
the portal vein and a
proximal intrahepatic portal
vein branch st.
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