Answer of June 2008

Clinical History:

A 75-year old male patient with history of diabetes and hypertension, was admitted for decreased consciousness and low grade fever. Blood results showed raised white cell count and deranged liver function. Ultrasound hepatobiliary system was performed.

Diagnosis:

Von Meyenburg complexes

Discussion:

Von Meyenburg complexes (biliary hamartomas) are benign liver lesions consisting of dilated bile duct structures with a surrounding fibrous stroma. They are benign liver malformations that are detected incidentally in 1% in children and 5-6% in adult. Usually they do not have pathological value and are incidental findings during autopsy or laparotomy. But malignant transformation and association with cholangiocarcinoma have been discussed and not yet proven. Association with Caroli’s syndrome, congenital hepatic fibrosis and autosomal dominant polycystic kidney disease has been reported.

Radiologically, they appear as multiple tiny bright echogenic foci in liver with distal ringdown artifact without obvious mass effect. These are related to the presence of cholesterol crystals. They are often confused with metastatic cancer, but metastases are usually hypoechoic and less commonly hyperechoic in ultrasound. Presence of ringdown artifact also makes metastases unlikely.