CHOLEDOCHAL CYST TYPE 4A .

1. CHOLEDOCHAL CYST Two year old female child with sonographic e/o dilated choledochus. MERCURY IMAGING INSTITUTE SCO 172-173 SEC 9C CHANDIGARH MERCURY IMAGING CENTRE SCO 16-17 SEC 20D CHANDIGARH

2. Choledochal cyst .................. Brief Extra hepatic bile duct dilatation with aneurysmal configuration. Female : Male ( 3:1) Etiopathogenesis : APBD – Anomalous Pancratobilliary drainage. Kimura type 1 :PB ( Pancreatic duct draining into the bile duct at 90 degree angle. Kimura type 2 :BP ( Bile duct inserting onto the pancreatic duct iat 90 degree angulation. Reflux of the pancreatic secretions leads to changes in the lining epithelium and susequent dilatation of the calibre of the CBD. High amylase in the bile contents of the choledochal cyst supports this etiopathogenesis. Children – Jaundice and acholic stools . Adults – Recurrent cholangitis , billiary colic . Complications – Billiary neoplasm. Choledochal cyst if drained – chances of maliganancy increase in it . USG : Cyst along the course of the CBD with cytic , hepatic , CHD leading to the cyst . Intrahepatic cystic dilatation is more central than peripheral .

3. TODANI CLASSIFICATION Type 1 a : Fusiform complete length dilatation of the CBD. Type 1 b : Focal fusiform dilatation of the CBD. Type 1 c : Cylindrical dilatation of the CBD. Type 2 : Focal diverticulum from the CBD. Type 3 : Choledochocele- Intramural / duodenal portion of the CBD. Type 4a : Dilatation of both intrahepatic / extrahepatic ducts. Type 4b : Dilatation of extrahepatic ducts Type 5 : Caroli’s disease : Cystic dilataion of the intraheptic ducts – Primarily central

4. FUSIFORM DILATATION OF THE CHOLEDOCHUS IS APPRECITED ALL THROUGH IT’S COURSE WITH DILATED INTRAHEPATIC DUCTS .

5. SAGITTAL PLANE FUSIFORM DILATATION OF THE CHOLEDOCHUS ALL THROUH IT’S COURSE.

6. HEAVY T2W THICK SLAB IMAGES . APPRECIATE THE DILATED MAIN HEPATIC DUCTS ON EITHER SIDE , CONFLUENCE OF THE DUCTS AND CHOLEDOCHUS ALL THORUGH IT’S COURSE . ( TYPE 4A CHOLEDOCHAL CYST )