E1392. Need A"Cyst"ance with the Right Upper Quadrant? A Review of Cystic Lesions of the Liver and Biliary Tree
  1. Joyce Joseph; University of Arkansas for Medical Sciences
  2. Roopa Ram; University of Arkansas for Medical Sciences
  3. Kedar Jambhekar; University of Arkansas for Medical Sciences
  4. Tarun Pandey; University of Arkansas for Medical Sciences
  5. Gitanjali Bajaj; University of Arkansas for Medical Sciences
The hepatobiliary system consists of the liver, gallbladder, and bile ducts; together, these structures produce and store bile, a critical component for digestion of lipids. For a radiologist, a thorough understanding of pathophysiology of the disease entities is crucial in correctly identifying pathology and to make an accurate diagnosis. A variety of imaging modalities are used in evaluation including ultrasound, CT, and perhaps most useful, MRI. This presentation will review cystic lesions of the liver and biliary system. These lesions range from benign and asymptomatic, to malignant and potentially fatal. Many of these lesions can be diagnosed on imaging alone, however, overlap between their features at times may make such diagnosis difficult. The presentation will go over characteristic imaging features of hepatobiliary cystic lesions and discuss imaging pearls and pitfalls, that will aid in accurate diagnosis and significantly impact patient management.

Educational Goals / Teaching Points
The educational format will be case based with a real patient history and clinical presentation. The same slide will contain radiologic images to demonstrate the pathology, as well as a brief description of the disease entity. The entities will be categorized under developmental, infectious, neoplastic, acquired/trauma related, and therapy related. The following entities will be reviewed: simple cysts, biliary hamartomas, multicystic biliary hamartomas, choledochal cyst, Caroli’s disease, polycystic liver disease, peribiliary cysts, intrahepatic biliary cysts, bacterial and amebic infections, hydatid cyst, primary and metastatic neoplasms, hematoma, seroma, biloma, and loco-regional therapy changes.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Anatomy of the hepatobiliary system and pathophysiology of the cystic lesions of the hepatobiliary system will be reviewed on ultrasound, CT, and MRI, with an overview of biliary ductal plate malformations.

Clear understanding of etiopathogenesis is essential to characterizing cystic hepatobiliary lesions. The wide spectrum of cystic lesions encountered in the hepatobiliary system makes radiologic diagnosis challenging at times. However, correct diagnosis can be made through awareness of key imaging findings, pearls, and pitfalls.