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Biliary Hamartomas, Von Meyenburg Complex

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

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presents with abdominal pain for which a non-

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contrast CT scan of the abdomen was performed.

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As we scroll through these images and we focus on the

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

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hypodense lesions scattered throughout the liver.

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

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

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

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

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all throughout the liver, a bunch of liver lesions

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that are difficult to confidently characterize, and

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an MRI was suggested, uh, for further evaluation.

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So here we have the MRI exam performed for this

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

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

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

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There are innumerable T2 hyperintense

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lesions scattered throughout this liver.

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

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images as well as the T2 fat-saturated sequence.

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

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example, in the posterior right hepatic lobe.

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Pretty hyperintense on the T2-weighted images with a

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signal that is very close to the cerebrospinal fluid signal.

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So, despite the multiplicity of these lesions,

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given their signal characteristics, I'm not

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too worried about them when I look at them.

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But we also note that a majority of them, for

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example, a whole bunch of them that are scattered

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here in the right and portion of the left

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hepatic lobe are quite small in size, right?

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

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

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

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So that becomes a key imaging feature when

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we talk about what this entity will be.

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As we go through our systematic approach, we're

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

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

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There are areas of susceptibility within these

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lesions, and we'll just focus on one particular

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lesion or a bunch of lesions seen in this slice.

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This one over here, for example, looks

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like it's hypointense in both the out

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of phase image and the in-phase image.

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It doesn't lose signal.

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

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

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

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Normally, we would then further evaluate these

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lesions with intravenous contrast; however, for this

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patient, could not get intravenous contrast; therefore,

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

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

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sequences to make a diagnosis of what this entity is.

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We can see, again, on the coronal image,

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scattered innumerable cystic lesions, quite small

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in size, seen all over the liver parenchyma.

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

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And this turns out to be an

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entity called biliary hamartomas.

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These are also known as von Meyenburg complexes, seen

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equal amounts between males and females, and they're

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seen in up to 3 percent of the general population.

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They're probably more common than we once realized,

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and they're almost always incidental and asymptomatic.

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Patients have normal liver function tests, so,

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nothing going to be abnormal over there, and

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no treatment is really needed for these cases.

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

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of these lesions, they can be completely cystic.

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

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Certainly when they're completely cystic, they'll

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have this appearance when you see multiple

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tiny cysts scattered throughout the liver.

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They may slowly increase in time, but by and

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

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worry about, and that you can make a confident

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diagnosis utilizing our MR imaging techniques.

Report

Faculty

Mahan Mathur, MD

Associate Professor, Division of Body Imaging; Vice Chair of Education, Dept of Radiology and Biomedical Imaging

Yale School of Medicine

Tags

MRI

Liver

Idiopathic

Gastrointestinal (GI)

Congenital

CT

Body

Acquired/Developmental

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