Keywords
choledochal cyst
biliary tract anomalies
Todani classification
How to Cite
Abstract
Introduction: Choledochal cysts are rare congenital anomalies of the biliary tree with significant risks of cholangitis, pancreatitis, and malignant transformation if not diagnosed early. Magnetic resonance cholangiopancreatography, a noninvasive, radiation-free technique, offers high-resolution multiplanar imaging of the entire biliary tree. This risk-free technique provides a safe diagnosis and extensive preoperative mapping, without the hazards of ionizing radiation and procedure-related complications, such as pancreatitis, that are commonly associated with other diagnostic techniques.
Case Report: A 67-year-old female presented with six months of intermittent right upper quadrant discomfort, some having had episodes of jaundice with pruritus. Laboratory studies were positive for hyperbilirubinemia (3.2 mg/dL) with a cholestatic enzyme pattern (alkaline phosphatase 320 U/L and γ-glutamyl transferase 190 U/L). Abdominal ultrasound revealed gallbladder sludge but was inconclusive for ductal anatomy.". Magnetic resonance cholangiopancreatography revealed an extrahepatic bile duct fusiform dilation up to 2.5 cm, consistent with a Todani type Ib choledochal cyst, with no intrahepatic bile duct dilatation or intraductal stones.
Conclusion: Magnetic resonance cholangiopancreatography is used for the early identification and description of biliary tract abnormalities, like choledochal cysts. Its non-invasive nature and global ductal mapping with a safety profile maximize surgical planning and potentially anticipate severe complications.
References
Lee, H. K., Park, S. J., Yi, B. H., Lee, A. L., Moon, J. H., & Chang, Y. W. (2009). Imaging features of adult choledochal cysts: a pictorial review. Korean journal of radiology, 10(1), 71–80. https://doi.org/10.3348/kjr.2009.10.1.71
Sato, M., Ishida, H., Konno, K., Naganuma, H., Ishida, J., Hirata, M., Yamada, N., & Watanabe, S. (2001). Choledochal cyst due to anomalous pancreaticobiliary junction in the adult: sonographic findings. Abdominal imaging, 26(4), 395–400. https://doi.org/10.1007/s002610000184
Vater A, Ezler C. Dissertatio de Scirrhis viserum occasione sections viri tymponite defunte. Wittenburgae Pamphlets. 1723;4:22
Huang CS, Huang CC, Chen DF. Choledochal cysts: differences between pediatric and adult patients. J Gastrointest Surg. 2010; 14:1105–1110. doi: https://doi.org/10.1007/s11605-010-1209-8
Soares, K. C., Arnaoutakis, D. J., Kamel, I., Rastegar, N., Anders, R., Maithel, S., & Pawlik, T. M. (2014). Choledochal cysts: presentation, clinical differentiation, and management. Journal of the American College of Surgeons, 219(6), 1167–1180. https://doi.org/10.1016/j.jamcollsurg.2014.04.023
Kim, O. H., Chung, H. J., & Choi, B. G. (1995). Imaging of the choledochal cyst. Radiographics: a review publication of the Radiological Society of North America, Inc, 15(1), 69–88. https://doi.org/10.1148/radiographics.15.1.7899614
Shi, L. B., Peng, S. Y., Meng, X. K., Peng, C. H., Liu, Y. B., Chen, X. P., Ji, Z. L., Yang, D. T., & Chen, H. R. (2001). Diagnosis and treatment of congenital choledochal cyst: 20 years experience in China. World journal of gastroenterology, 7(5), 732–734. https://doi.org/10.3748/wjg.v7.i5.732
Komi, N., Udaka, H., Ikeda, N., & Kashiwagi, Y. (1977). Congenital dilatation of the biliary tract; new classification and study with particular reference to anomalous arrangement of the pancreaticobiliary ducts. Gastroenterologia Japonica, 12(4), 293–304. https://doi.org/10.1007/BF02776798
Babbitt, D. P., Starshak, R. J., & Clemett, A. R. (1973). Choledochal cyst: a concept of etiology. The American Journal of roentgenology, Radium Therapy, and Nuclear Medicine, 119(1), 57–62. https://doi.org/10.2214/ajr.119.1.57
Iwai, N., Yanagihara, J., Tokiwa, K., Shimotake, T., & Nakamura, K. (1992). Congenital choledochal dilatation with emphasis on the pathophysiology of the biliary tract. Annals of Surgery, 215(1), 27–30. https://doi.org/10.1097/00000658-199201000-00003
Radswiki T, Bell D, Alhusseiny K, et al. Todani classification of bile duct cysts. Reference article, Radiopaedia.org (Accessed on Jun 18, 2025) https://doi.org/10.53347/rID-12081
Gaillard F, Choledochal cyst types (diagram). Case study, Radiopaedia.org (Accessed on Jun 18, 2025) https://doi.org/10.53347/rID-8097
Mohammad Alizadeh A. H. (2017). Cholangitis: Diagnosis, Treatment and Prognosis. Journal of clinical and translational hepatology, 5(4), 404–413. https://doi.org/10.14218/JCTH.2017.00028
Caraiani, C., Yi, D., Petresc, B., & Dietrich, C. (2020). Indications for abdominal imaging: When and what to choose? Journal of ultrasonography, 20(80), e43–e54. https://doi.org/10.15557/JoU.2020.0008
Joshi, A., Rajpal, K., Kakadiya, K. et al. Role of CT and MRCP in Evaluation of Biliary Tract Obstruction. Curr Radiol Rep 2, 72 (2014). https://doi.org/10.1007/s40134-014-0072-x
DeAngelis, N., Catena, F., Memeo, R., et al. (2020). WSES guidelines for the detection and management of bile duct injury during cholecystectomy. World J Emerg Surg 16, 30 (2021). https://doi.org/10.1186/s13017-021-00369-w
Kumar, A., Mohanty, N. R., Mohanty, M., & Dash, S. (2023). Comparison of MRCP and ERCP in the evaluation of common bile duct and pancreatic duct pathologies. Frontiers in medical technology, 5, 946555. https://doi.org/10.3389/fmedt.2023.946555
Bierig SM, Jones A. Accuracy and Cost Comparison of Ultrasound Versus Alternative Imaging Modalities, Including CT, MR, PET, and Angiography. Journal of Diagnostic Medical Sonography. 2009;25(3):138-144. doi:10.1177/8756479309336240
Hoilat GJ, John S. Choledochal Cyst. [Updated 2023 Aug 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557762/
Li, P., Zhang, Z., Li, J., Jin, L., Han, W., & Zhang, J. (2014). Diagnostic value of magnetic resonance cholangiopancreatography for secondary common bile duct stones compared with laparoscopic trans-cystic common bile duct exploration. Medical science monitor: international medical journal of experimental and clinical research, 20, 920–926. https://doi.org/10.12659/MSM.890831