Diagnostic ultrasound ( PDFDrive )

1736 PART V Pediatric Sonography
A
B
FIG. 51.6 Choledochal Cyst Type I in Infant With Jaundice. (A) Transverse sonogram. A large cyst that is the greatly dilated common bile
duct is visible entering the pancreatic head. (B) Intraoperative cholangiogram shows injection of the gallbladder and illing of the choledochal cyst
(arrow).
A
B
FIG. 51.7 Biliary Ductal Dilation. (A) Caroli disease, type V choledochal cyst. Longitudinal color Doppler image of the left lobe of the liver
shows saccular dilation of bile ducts with thickened echogenic walls and few vessels in the deeper aspect of the liver. Cholangitis, caused by
obstruction of the bile ducts or by ascending infection, leads to dilation of the intrahepatic and common bile ducts. (B) Central bile duct dilation on
transverse sonogram in a different patient, with concentric smooth dilation of main intrahepatic duct (arrowhead) caused by distal common bile
obstruction.
is used to document bile low into the cyst, and percutaneous
cholecystography/cholangiography or endoscopic retrograde
cholangiopancreatography is performed if detailed mapping of
the bile system is deemed necessary before surgery.
Caroli disease (type V choledochal cyst) consists of nonobstructive
dilation of intrahepatic bile ducts 8,9 and is oten
associated with congenital hepatic ibrosis and autosomal recessive
polycystic kidney disease. 10 he disease is caused by the arrest of
or derangement in embryologic remodeling of ducts, resulting
in segmental dilation. Patients tend to seek medical attention
later than with other types of choledochal cysts, usually ater
cholangitis and stones have formed in childhood (Fig. 51.7). At
sonography, Caroli disease has dilated ducts surrounding branches
of the portal vein. 9 Sludge and stones are oten visible within