What is the role of ultrasonography in the workup of choledochal cysts?

Updated: Jul 01, 2020
  • Author: Emily Tommolino, MD; Chief Editor: BS Anand, MD  more...
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Abdominal ultrasonography is the test of choice for the diagnosis of a choledochal cyst. Ultrasonography is useful in the antenatal period as well and can demonstrate a choledochal cyst in a fetus as early as the beginning of the second trimester. [1, 25] Caroli disease has also been detected antenatally with ultrasound by Sgro and colleagues. [2] (See image below.)

Diagnostic ultrasonogram demonstrating a type I ch Diagnostic ultrasonogram demonstrating a type I choledochal cyst in a 4-month-old child presenting with hyperbilirubinemia and transaminase elevations.

Endoscopic ultrasonography (EUS) appears to have the potential to differentiate between choledochal and pancreatic cysts, particularly in patients with type II choledochal cysts. [26] It is not limited by bowel gas, intraabdominal structures, or body habitus compared to abdominal ultrasonography. In a retrospective review (2010-2014) of 4 women with either type II cysts, equivocal for choledochal cyst on magnetic resonance imaging (MRI), or the possibility of branch-duct intraductal papillary mucinous neoplasm of the pancreas on computed tomography (CT) scan, EUS was able to demonstrate no communication in all cases between the choledochal structure and the common bile duct. [26] Moreover, EUS-guided fluid aspiration could be used for further testing to differentiate between biliary cysts and other cystic structures. [26]

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