Case 3

This is an MRI liver and MRCP study, showing innumerable small, rounded well defined lesions of similar size scattered throughout the liver. These lesions show very high T2 signal and low T1 signal, consistent with fluid and revealing them to be cystic lesions.

The MRCP images demonstrate no communication between these lesions and the biliary tree, which appears normal.

The DWI series shows no diffusion restriction. The lesions are not enhancing on the post-contrast series, which proves that they have no solid component.

These lesions most likely represent biliary hamartomas, or Von Meyenburg complexes.

The differential diagnosis includes simple cysts- however these would not exhibit the same uniform size and distribution as is demonstrated in this case. Caroli’s disease is another consideration; however, the cysts would be larger and would communicate with the biliary tree.

I would communicate the findings with the referring physician; in the vast majority of cases, no further management is required.