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Congenital Anomalies and Normal Variants of the Pancreaticobiliary Tract and the Pancreas in Adults: Part 1, Biliary Tract

Jinxing Yu1, Mary Ann Turner1, Ann S. Fulcher1 and Robert A. Halvorsen1

1 All authors: Department of Radiology, VCU Health Systems, Virginia Commonwealth University, 1250 East Marshall St., Richmond, VA 23298.


Figure 1
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  		Fig. 1 —Normal and variant biliary ducts. A, Normal biliary tree. B, Trifurcation of biliary duct (arrow). C, Right dorsocaudal branch (arrow) draining into left hepatic duct. D, Aberrant right hepatic duct (arrow) emptying into common hepatic duct. E, Aberrant right hepatic duct (arrow) draining into cystic duct.

 

Figure 2
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  		Fig. 2 —51-year-old man imaged for liver donor work-up. Coronal thick-slab MR cholangiopancreatography reveals dorsocaudal branch of right hepatic duct (arrows) draining into left hepatic duct (arrowhead). Aberrant right hepatic duct (open arrow) drains into common hepatic duct. Common bile duct (CBD), cystic duct (curved arrow), pancreatic duct (P), duodenum (D), and biliary bifurcation (bif) are noted.

 

Figure 3
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  		Fig. 3 —46-year-old woman undergoing surgery for liver donor transplantation. Intraoperative cholangiogram reveals dorsocaudal branch (arrows) of right hepatic duct emptying into left hepatic duct. Common bile duct (CBD), duodenum (D), and biliary bifurcation (bif) are noted.

 

Figure 4
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  		Fig. 4 —57-year-old woman with abdominal pain. Coronal thick-slab MR cholangiopancreatography shows right aberrant biliary duct (open arrows) draining into common hepatic duct. Cystic duct remnant is noted (curved arrow). Common bile duct (CBD), pancreatic duct (P), duodenum (D), and biliary bifurcation (bif) are noted.

 

Figure 5
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  		Fig. 5 —44-year-old woman with chronic pancreatitis. Coronal thick-slab MR cholangiopancreatography shows cystic duct (arrows) with low insertion (arrowhead) into distal common bile duct (cbd). Gallbladder (GB) is noted.

 

Figure 6
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  		Fig. 6 —40-year-old woman with bile leak after cholecystectomy. ERCP image shows cystic duct remnant (arrows) insertion into aberrant right hepatic duct (open arrows). Biliary bifurcation (bif) and common bile duct (CBD) are noted.

 

Figure 7
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  		Fig. 7A —Classification of bile duct cysts. Type 1, fusiform dilation (arrows) of common bile duct.

 

Figure 8
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  		Fig. 7B —Classification of bile duct cysts. Type 2, diverticulum (arrows) originating from common bile duct.

 

Figure 9
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  		Fig. 7C —Classification of bile duct cysts. Type 3, choledochocele (arrows).

 

Figure 10
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  		Fig. 7D —Classification of bile duct cysts. Type 4A, fusiform dilation of extrahepatic bile duct (arrows) and cystic dilation of intrahepatic biliary ducts (open arrows).

 

Figure 11
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  		Fig. 7E —Classification of bile duct cysts. Type 4B, multiple cystic dilations involving only extrahepatic bile duct (arrows).

 

Figure 12
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  		Fig. 7F —Classification of bile duct cysts. Type 5, cystic dilation (arrows) of the intrahepatic bile ducts only (Caroli's disease).

 

Figure 13
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  		Fig. 8A —50-year-old woman with jaundice. Coronal thick-slab MR cholangiopancreatography shows large type 1 bile duct cyst of extrahepatic bile duct (arrows). Right and left hepatic ducts are slightly distended (open arrows). Gallbladder (GB) and duodenum (D) are noted.

 

Figure 14
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  		Fig. 8B —50-year-old woman with jaundice. Percutaneous transhepatic cholangiogram of same patient shows large type 1 bile duct cyst of extrahepatic bile duct containing contrast material (arrows). Slightly distended left and right hepatic ducts are noted (open arrows). Percutaneous needle (Perc), gallbladder (GB), and duodenum (D) are noted.

 

Figure 15
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  		Fig. 9A —30-year-old man with periampullary mass seen on CT performed at another institution. Coronal oblique, thin-slab MR cholangiopancreatography (MRCP) image reveals oval-shaped high-signal-intensity contour (arrows) of distal common bile duct (CBD) protruding into duodenum (D), which represents choledochocele. Pancreatic duct (P) is noted.

 

Figure 16
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  		Fig. 9B —30-year-old man with periampullary mass seen on CT performed at another institution. Axial T2-weighted image shows fluid-filled structure (arrows) protruding into duodenum (D). Pancreas (P) is noted.

 

Figure 17
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  		Fig. 9C —30-year-old man with periampullary mass seen on CT performed at another institution. ERCP image shows contrast-filled and oval-shaped structure (arrows) of distal common bile duct (CBD) protruding into duodenum (D), which represents choledochocele seen at MRCP and MR.

 

Figure 18
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  		Fig. 10A —54-year-old man with abdominal mass and pain. Sonogram shows aneurysmal dilation of extrahepatic bile duct (arrows). Dotted line between arrows represents measurement line of sonogram.

 

Figure 19
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  		Fig. 10B —54-year-old man with abdominal mass and pain. Coronal oblique, thin-slab MR cholangiopancreatography shows marked dilation of extrahepatic bile duct (solid arrows) and left main intrahepatic duct (open arrow).

 

Figure 20
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  		Fig. 11A —70-year-old woman with jaundice. Coronal oblique, thin-slab MR cholangiopancreatography shows multiple cystic dilations of intrahepatic bile ducts (arrows) consistent with Caroli's disease. Common bile duct (CBD), duodenum (D), and pancreatic duct (P) are noted.

 

Figure 21
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  		Fig. 11B —70-year-old woman with jaundice. Coronal T2-weighted image shows multiple fluid-containing foci (arrowheads) in papillae of kidneys, indicating renal tubular ectasia (medullary sponge kidney). Saccular dilations of intrahepatic bile ducts (arrows) are noted.

 

Figure 22
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  		Fig. 12A —65-year-old man with hepatitis B. Coronal thick-slab MR cholangiopancreatography shows situs inversus with gallbladder (GB), common bile duct (CBD), and second portion of duodenum (D) in left upper quadrant, and pancreatic duct (P) coursing toward right. High signal intensity focus in right upper quadrant (S) represents fluid in stomach.

 

Figure 23
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  		Fig. 12B —65-year-old man with hepatitis B. Axial CT shows gallbladder (GB) and liver (L) located in left upper abdomen, and stomach (S) and spleen (Sp) in right upper abdomen. Splenic vein (v) is noted.

 

Figure 24
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  		Fig. 13 —42-year-old woman with polysplenia syndrome. Axial CT scan shows two spleens (Sp) to right of midline. Gallbladder (GB) is near midline and stomach (S) is on right. Pancreas is foreshortened (P).

 

Figure 25
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  		Fig. 14A —49-year-old woman with pancreatitis. Coronal oblique, thin-slab MR cholangiopancreatography shows 2.4-cm-long common channel (double arrows) distal to union of distal common bile duct (CBD) and pancreatic duct (P). Major papilla (open arrow) and duodenum (D) are noted. Mid common bile duct is focally dilated, which is consistent with type 1 bile duct cyst (Cyst).

 

Figure 26
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  		Fig. 14B —49-year-old woman with pancreatitis. Schematic of A. The double arrows represent long common channel from orifice of papilla (open arrow) to union of distal common bile duct (CBD) and pancreatic duct (P). Mid common bile duct is focally dilated, which is consistent with type 1 bile duct cyst (Cyst). Duodenum is noted (D).

 

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