title: Preoperative imaging does not predict intrahepatic involvement in choledochal cysts.
abstract: BACKGROUND
  Choledochal cyst (CDC) is a congenital malformation of the bile ducts, which can include the intrahepatic or extrahepatic bile ducts. We hypothesize that preoperative intrahepatic ductal dilation is not predictive of postoperative intrahepatic involvement.
  
  
  METHODS
  We retrospectively reviewed all cases of CDC in children diagnosed at a single institution between 1991 and 2013.
  
  
  RESULTS
  Sixty-two patients were diagnosed with CDC during the study period with a median follow-up time of 2.25 (range 0-19.5) years. Forty-two patients (68%) were diagnosed with type I disease preoperatively, and 15 patients (24%) were diagnosed with type IV-A disease. The most common presenting symptoms included pain (34%), jaundice (28%), and pancreatitis (25%). There were no deaths or malignancies and only one postoperative stricture. Forty-two patients (68%) had intrahepatic ductal dilation preoperatively. Only four patients (9%) had intrahepatic ductal dilation following resection (P<0.0001). In one patient, this dilation resolved following stricture revision. Of the four patients with postoperative dilation, two were diagnosed with type I disease, and the other two were diagnosed with type IV-A disease preoperatively.
  
  
  CONCLUSIONS
  Preoperative intrahepatic ductal dilation is not predictive of postoperative intrahepatic ductal involvement in children with CDC. The preoperative distinction between type I and IV disease is not helpful in treating these patients.
authors: Department of Surgery, Division of Pediatric Surgery, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO 80045, USA. Electronic address: shannon.acker@ucdenver.edu.
authors: Shannon N
authors: SN
authors: Acker
authors: Jennifer L
authors: JL
authors: Bruny
authors: Michael R
authors: MR
authors: Narkewicz
authors: Jonathan P
authors: JP
authors: Roach
authors: Andrew
authors: A
authors: Rogers
authors: Frederick M
authors: FM
authors: Karrer
mesh_terms: D000293:Adolescent; D001653:Bile Ducts, Intrahepatic / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D015529:Choledochal Cyst / Q000145:classification / Q000175:diagnosis / Q000601:surgery*; D004108:Dilatation, Pathologic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011300:Preoperative Care; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Choledochal cysts; Jaundice; Pancreatitis; Preoperative imaging; Todani's classification