IS Case 156: Biliary Hamartoma

Scott Cassar, MD


Imaging Sciences URMC 2008
Publication Date: 2009-05-21

History

Patient is a 45-year-old female with a two day history of right upper quadrant abdominal and epigastric pain. Clinical suspicion of cholecystitis. Patient was found to have a partial small bowel obstruction on subsequent CT exam.

Findings

Incidentally found complex hyperechoic lesion in the posterior right hepatic lobe with dirty shadowing. This did not change with patient position and there was no internal flow.

Diagnosis

Biliary Hamartoma

Discussion

Bile duct hamartomas are benign tumors composed of disorganized bile ducts and fibrocollagenous stroma. They typically are small and scattered but may coalesce into larger masses. They are located at the edges of portal tracts and are not connected with the biliary system.

Biliary hamartomas are associated with autosomal dominant polycystic kidney disease, polycystic liver disease, Caroli disease, and congenital hepatic fibrosis. They may be misdiagnosed as multiple liver metastases, microabscesses, lymphoma, leukemia, Candida albicans, or extrapulmonary Pneumocystis carinii infection at initial imaging. First described by von Meyenburg in 1918, biliary hamartomas are often referred to as von Meyenburg complexes.

With ultrasound, biliary hamartomas have been described as innumerable tiny hypoechoic or hyperechoic foci measuring less than 10 mm and distributed uniformly throughout the liver. Differences in echogenicity may be due to the size of the dilated bile duct component which may behave like other microcystic structures and show echogenicity. On subsequent CT, this lesion appeared cystic and measured water density with no appreciable enhancement.

References

  1. Weissleder R, Wittenberg J, Harisinghani MG, Chen JW, et al. Primer of Diagnostic Imaging. 4th ed. Philadelphia, PA: Mosby, 2006.
  2. Markhardt BK, Rubens DJ, Huang J, Dogra VS. Sonographic features of biliary hamartomas with histopathologic correlation. J Ultrasound Med. 2006 Dec;25(12):1631-3. [PMID: 17121964]

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