Case 6

This is an MRI liver and MRCP study showing extreme saccular enlargement or dilatation of the CBD, CHD and cystic duct with abrupt transition to normal calibre at the distal CBD prior to the junction with the pancreatic duct- there is also dilatation of the intrahepatic duct, but this appears more regular and less fusiform in shape. There is a fluid – fluid level within the CBD, indicating layering of sludge. The pancreatic duct shows normal calibre. There is no obstructing lesion at the lower CBD / ampulla. There are no filling defects / stones at the point of transition at the lower CBD. No pancreatitis.

The appearance of the CBD and CHD are characteristic of a type I choledochal cyst, causing secondary / obstructive dilatation of the intrahepatic bile ducts. I would suggest discussion of this case at hepatobiliary surgery MDT.