title: Giant and complicated variants of cystic bile duct hamartomas of the liver: MRI findings and pathological correlations.
abstract: OBJECTIVE
  To describe a new category of liver cyst we propose calling "giant bile duct hamartoma (giant-BDH)" and to provide a more complete record of the magnetic resonance imaging (MRI) features of BDHs with potential for clinical impact.
  
  
  METHODS
  This study was Institutional Review Board (IRB)-approved and Health Insurance Portability and Accountability Act (HIPPA)-compliant. Fifteen patients were identified with surgical liver pathology in keeping with complicated BDH and MRI findings of giant cysts.
  
  
  RESULTS
  In all, 14/15 patients presented with pain that resolved in 14/14 with surgery. Imaging features common to pretreatment cysts included sharply defined, lobulated margins with thin, smooth rim-enhancement. Treated symptomatic cysts measured 9.8 cm on average and 21.6 cm maximum. The 14/15 patients had coexistent <2.0 cm BDH. Elevated T1 signal corresponded with hemorrhagic cyst content (10/15 patients); cyst-wall rim-enhancement corresponded with histological findings of inflammation (15/15), fibrocystic changes (12/15), and smaller BDH in the adjacent liver (13/15). Histology of giant-BDH cyst walls corresponded with complicated BDH in 15/15. The incidence of symptomatic-treated BDH at our institution was 0.4%.
  
  
  CONCLUSIONS
  BDH is a benign hepatic cystic lesion that may undergo cystic enlargement, internal hemorrhage, and clinically present with abdominal pain treatable by minimally invasive laparoscopic fenestration. Complicated giant-BDH coexists with smaller BDH and the MRI features of giant-BDH are characteristic.
authors.affiliation: Emory University School of Medicine, Department of Radiology, Atlanta, Georgia 30322, USA. dmartin@emory.edu
authors.forename: Diego R
authors.initials: DR
authors.lastname: Martin
authors.forename: Bobby
authors.initials: B
authors.lastname: Kalb
authors.forename: Juan M
authors.initials: JM
authors.lastname: Sarmiento
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Heffron
authors.forename: Ipek
authors.initials: I
authors.lastname: Coban
authors.forename: N Volkan
authors.initials: NV
authors.lastname: Adsay
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000145:classification* / Q000473:pathology*; D003560:Cysts / Q000473:pathology; D005260:Female; D006222:Hamartoma / Q000145:classification* / Q000473:pathology*; D006470:Hemorrhage / Q000473:pathology; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007249:Inflammation; D008099:Liver / Q000473:pathology; D008113:Liver Neoplasms / Q000145:classification* / Q000473:pathology*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged