INTRODUCTION:
Peribiliary cysts are a rare entity usually found in patients with chronic liver disease and polycystic kidney disease. Patients are mostly asymptomatic therefore it is identified at times incidentally by abdominal imaging. Differential diagnosis include cholangiocarcinoma, Caroli disease and primary biliary cirrhosis. Awareness is essential to avoid misdiagnosis and unnecessary procedures including biopsies and surgeries.
CASE DESCRIPTION/METHODS:
A 67-year-old female with cirrhosis secondary to NASH and portal hypertension, among other comorbidities was evaluated at GI clinics. Abdominal sonogram performed for hepatocellular carcinoma surveillance showed right and left intrahepatic biliary ductal dilatation. The common bile duct measured 0.35 cm and the gallbladder showed intraluminar posterior acoustic shadows suggestive of cholelithiasis without wall thickening or pericholecystitic fluid collections. Patient denied fever, chills, abdominal pain, nausea or vomits. Abdomen was benign. Laboratories remarkable for baseline thrombocytopenia of 71, normal ALT and AST, elevation of alkaline phosphatase to 171 and hyperbilirubinemia of 3. MRCP was performed for further evaluation which showed multiple hyperintense rounded lesions tracking along the intrahepatic and extrahepatic biliary as seen with peribiliary cysts.
DISCUSSION:
Peribiliary cyst are usually associated to alcoholic cirrhosis with a prevalence of 9%; while in they have not been described in NASH. Pathophysiology may be due to intrahepatic circulatory disturbances of the portal venous system. Possible complications include biliary tract dilatation, obstructive jaundice and cholangitis.
Ishita Banerjee-Dube y Saurabh Dube (eds.). De lo antiguo a lo moderno: religión, poder y comunidad en la India. México: El Colegio de México, 2011. 579 pp.
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