0:00

The next case is a 37-year-old female who

0:03

presents with abdominal pain for which a non-

0:05

contrast CT scan of the abdomen was performed.

0:08

As we scroll through these images and we focus on the

0:10

liver, we can see that there are multiple ill-defined

0:14

hypodense lesions scattered throughout the liver.

0:17

We were just to window this to bring them out a little

0:19

bit more, you can see at the dome of the liver there's

0:21

one over here, one over here, there's a couple that

0:24

are a little bit larger, two over here, and, uh,

0:27

all throughout the liver, a bunch of liver lesions

0:29

that are difficult to confidently characterize, and

0:33

an MRI was suggested, uh, for further evaluation.

0:36

So here we have the MRI exam performed for this

0:40

patient, and as we scroll through our, uh, sets of

0:42

T2-weighted images, we can see that the lesions we

0:45

saw in the CT scan were just the tip of the iceberg.

0:48

There are innumerable T2 hyperintense

0:52

lesions scattered throughout this liver.

0:54

And these are pretty well seen in both the T2-weighted

0:56

images as well as the T2 fat-saturated sequence.

0:59

Um, we can see a few of them here, um, for

1:02

example, in the posterior right hepatic lobe.

1:04

Pretty hyperintense on the T2-weighted images with a

1:06

signal that is very close to the cerebrospinal fluid signal.

1:09

So, despite the multiplicity of these lesions,

1:13

given their signal characteristics, I'm not

1:14

too worried about them when I look at them.

1:17

But we also note that a majority of them, for

1:19

example, a whole bunch of them that are scattered

1:21

here in the right and portion of the left

1:23

hepatic lobe are quite small in size, right?

1:26

At most, maybe, one of these lesions may be 15 to 20

1:30

millimeters, but most of them are about 5 to 10 millimeters

1:33

in size, and a lot of them are even smaller than that.

1:36

So that becomes a key imaging feature when

1:37

we talk about what this entity will be.

1:40

As we go through our systematic approach, we're

1:42

then going to go on to the out-of-phase images and

1:44

the in-phase image just to see if there's any fat.

1:47

There are areas of susceptibility within these

1:48

lesions, and we'll just focus on one particular

1:52

lesion or a bunch of lesions seen in this slice.

1:54

This one over here, for example, looks

1:56

like it's hypointense in both the out

1:58

of phase image and the in-phase image.

1:59

It doesn't lose signal.

2:01

As we will scroll through these images, you can see that

2:03

none of the liver lesions lose signal, so they don't contain

2:06

fat; they don't contain areas of increased susceptibility.

2:09

Normally, we would then further evaluate these

2:11

lesions with intravenous contrast; however, for this

2:14

patient, could not get intravenous contrast; therefore,

2:16

we have to make do with the images that we have.

2:18

But, really, there's enough information on the T2-weighted

2:22

sequences to make a diagnosis of what this entity is.

2:26

We can see, again, on the coronal image,

2:28

scattered innumerable cystic lesions, quite small

2:31

in size, seen all over the liver parenchyma.

2:33

Some are a little bit larger, as you can see over here.

2:36

And this turns out to be an

2:37

entity called biliary hamartomas.

2:42

These are also known as von Meyenburg complexes, seen

2:49

equal amounts between males and females, and they're

2:53

seen in up to 3 percent of the general population.

2:55

They're probably more common than we once realized,

2:58

and they're almost always incidental and asymptomatic.

3:01

Patients have normal liver function tests, so,

3:04

nothing going to be abnormal over there, and

3:06

no treatment is really needed for these cases.

3:09

Now, as it turns out, if you look at the pathology

3:11

of these lesions, they can be completely cystic.

3:15

They can be solid or a little bit of a mixed component.

3:18

Certainly when they're completely cystic, they'll

3:20

have this appearance when you see multiple

3:22

tiny cysts scattered throughout the liver.

3:24

They may slowly increase in time, but by and

3:27

large, these are lesions that you don't need to

3:29

worry about, and that you can make a confident

3:32

diagnosis utilizing our MR imaging techniques.