Multiple biliary microhamartomas diagnosed in an unsuspecting elderly patient

Abstract

Multiple biliary hamartomas are a benign incidental finding in the liver. They are not easily detected if one has never seen them, and if appropriate imaging tests are unavailable, and also can be challenging to differentiate from other liver lesions based on imaging alone. Thus, this study aimed to expand the radiologist’s digital image library, enabling a quick and precise differential diagnosis. This paper also highlights the importance of thorough radiological assessment and need for a multidisciplinary approach, involving radiologists, hepatologists, and pathologists, to ensure a precise diagnosis. The patient presented at the hospital for a computed tomography scan and an abdominal magnetic resonance imaging recommended by his general practitioner to assess the biliary tree (magnetic resonance cholangiopancreatography), owing to persistent abdominal pain. The patient had never undergone an abdominal magnetic resonance imaging previously; hence, the discovery of hepatic lesions was incidental and unexpected. Magnetic resonance imaging revealed multiple benign lesions in both the hepatic lobes comparable to the Von Meyenburg complex. These lesions are multiple hamartomas and behave differently in all magnetic resonance imaging sequences. Images acquired with different magnetic resonance imaging sequences were carefully examined. Multiple lesions were found scattered throughout the liver; however, the lesions were benign and consistent with the diagnosis of multiple biliary hamartomas. Medical practitioners should examine the presence of multiple biliary hamartomas and consider them in the differential diagnosis when patients present with hepatic abnormalities. This can prevent unnecessary interventions and guide appropriate patient management.

Keywords

• liver
• hamartomas
• von meyenburg complex
• magnetic resonance imaging
• diagnostic imaging
• magnetic resonance cholangiography
• bile duct neoplasms