ISOLATED CYSTIC DILATATION OF THE LEFT INTRAHEPATIC BILIARY TREE: A RARE CAUSE OF RECURRENT CHOLANGITIS arpadpanyko@rocketmail.com

 

ISOLATED CYSTIC DILATATION OF THE LEFT INTRAHEPATIC BILIARY TREE: A RARE CAUSE OF RECURRENT CHOLANGITIS

4

Slovakia

Poster Exhibition only

Isolated intrahepatic biliary dilatation confined to a single hepatic lobe is exceptionally rare. When associated with recurrent cholangitis, segmental liver pathology poses significant diagnostic and therapeutic challenges.

70-year-old patient presented with cystic dilatation of the biliary tree localized exclusively to the left hepatic lobe and recurrent episodes of acute cholangitis over one year. Each episode was managed with endoscopic retrograde cholangiopancreatography (ERCP) and temporary biliary drainage. Magnetic resonance cholangiopancreatography (MRCP) revealed marked left lobe atrophy due to chronic cholestasis, extending to the confluence of hepatic ducts and into the common bile duct. The distribution of biliary changes suggested possible underlying Von Meyenburg complexes. Reduced T2 signal intensity raised suspicion for hepatic iron overload consistent with hemochromatosis. Chronic occlusion of the left portal vein and hepatic vein was also noted. Three-dimensional reconstruction provided detailed visualization for treatment planning.

Therapy consisted of serial ERCP every three months, with SpyGlass cholangioscopy for direct inspection and balloon-assisted lithiasis extraction. Biliary drainage was maintained via plastic stents with regular exchange. The patient showed sustained clinical improvement without the need for hepatic resection.

This case highlights a rare presentation of unilateral cystic intrahepatic biliary dilatation complicated by recurrent cholangitis. MRCP combined with 3D reconstruction offers critical non-invasive anatomical detail, guiding diagnosis and management in complex biliary disorders.