Application Value of Two-Dimensional Ultrasound Combined with Contrast-Enhanced Ultrasound for the Diagnosis of Multiple Bile Duct Hamartomas: A Case Report

doi:10.37015/AUDT.2021.200064

Abstract

Abstract:

Bile duct hamartomas (BDHs), also known as von Meyenburg complexes, are small neoplasms of the liver, of which the pathology is a benign bile duct malformation. We report a case of multiple BDHs of a 55-year-old male diagnosed using two-dimensional (2-D) ultrasound combined with contrast-enhanced ultrasound (CEUS) and further clinically diagnosed using magnetic resonance imaging (MRI) and magnetic resonance cholangiopancreatography (MRCP). The 2-D ultrasound showed diffusely distributed hyperechoic nodules and cystic masses in the liver, accompanied by small strong echoes with a comet tail sign. The CEUS showed that the hyperechoic nodules observed no abnormal enhancement in the arterial phase and equal enhancement with the surrounding liver tissue in the portal vein and delayed phase. We conclude that the appearance of BDHs on ultrasound has distinct characteristics and can be used as the preferred method for diagnosis. The CEUS can differentially diagnose the disease and improve diagnostic accuracy. Therefore, 2-D ultrasound, combined with CEUS, is a helpful method for diagnosing BDHs.

Key words: Bile duct hamartoma; Ultrasound; Contrast-enhanced ultrasound; Diagnosis

Tong Zhang, MD, Xiaolin Yin, Shuang Zheng, MD, Mingwei Sui, MD, Dezhi Zhang, MD. Application Value of Two-Dimensional Ultrasound Combined with Contrast-Enhanced Ultrasound for the Diagnosis of Multiple Bile Duct Hamartomas: A Case Report. Advanced Ultrasound in Diagnosis and Therapy, 2021, 5(4): 317-320.

References

[1]	Lin S, Weng Z, Xu J, Wang MF, Zhu YY, Jiang JJ. A study of multiple biliary hamartomas based on 1697 liver biopsies. Eur J Gastroenterol Hepatol 2013; 25: 948-952.
[2]	Redston MS, Wanless IR. The hepatic von meyenburg complex: prevalence and association with hepatic and renal cysts among 2843 autopsies [corrected]. Mod Pathol 1996; 9: 233-237.
[3]	Watanabe M, Shiozawa K, Ikehara T, Sato A, Matsui D, Ogino Y, et al. A case of solitary bile duct hamartoma with advanced gastric carcinoma: findings in contrast-enhanced ultrasonography. J Med Ultrason(2001) 2014; 41: 203-207.
[4]	Pech L, Favelier S, Falcoz MT, Loffroy R, Krause D, Cercueil JP. Imaging of von meyenburg complexes. Diagn interv imaging. 2016; 97: 401-409.
[5]	Semelka RC, Hussain SM, Marcos HB, Woosley JT. Biliary hamartomas: solitary and multiple lesions shown on current MR techniques including gadolinium enhancement. J Magn Reson Imaging 1999; 10: 196-201.
[6]	Salles VJ, Marotta A, Netto JM, Speranzini MB, Martins MR. Bile duct hamartomas--the von meyenburg complex. Hepatobiliary Pancreat Dis Int 2007; 6: 108-109.
[7]	Merkel D, Wiens D, Kämmer J. The "dirty liver" as a coincidental finding on sonography: sonographic criteria for biliary microhamartomas of the liver. J Ultrasound Med 2016; 35: 2139-2145.
[8]	Lung PF, Jaffer OS, Akbar N, Sidhu PS, Ryan SM. Appearances of von meyenburg complex on cross sectional imaging. J Clin Imaging Sci 2013; 3: 22.
[9]	Berry JD, Boxer ME, Rashid HI, Sidhu PS. Case report: microbubble contrast-enhanced ultrasound characteristics of multiple biliary hamartomas (von meyenberg complexes). Ultrasound 2004; 12: 95-97.
[10]	Murphy-Lavallee J, Jang HJ, Kim TK, Burns PN, Wilson SR. Are metastases really hypovascular in the arterial phase? The perspective based on contrast-enhanced ultrasonography. J Ultrasound Med 2007; 26: 1545-1556.
[11]	Parekh V, Peker D. Malignant transformation in von-meyenburg complexes: histologic and immunohistochemical clues with illustrative cases. Appl Immunohistochem Mol Morphol 2015; 23: 607-614.
[12]	Gupta A, Peker D, Pattnaik B, Das A, Kaman L. Von Meyenburg complex and complete ductal plate malformation along with Klatskin tumour: a rare association. BMJ Case Rep 2016; 2016: 10.1136/bcr-2016-215220.
[13]	Mimatsu K, Oida T, Kawasaki A, Aramaki O, Kuboi Y, Katsura Y, et al. Preoperatively undetected solitary bile duct hamartoma (von Meyenburg complex) associated with esophageal carcinoma. Int J Clin Oncol 2008; 13: 365-368.

[1]	Keyan Li, MD, Faqin Lv, MD, Junlai Li, MD. Clinical Application of Robot-assisted Teleultrasound [J]. Advanced Ultrasound in Diagnosis and Therapy, 2023, 7(3): 228-234.
[2]	Leila Bayani, MD, Donya Goodarzi, BS, Reza Mardani, MD, Bita Eslami, PhD, Sadaf Alipour, MD. Localization of Nonpalpable Breast Lumps by Ultrasound Local Coordinates and Skin Inking: A Randomized Controlled Trial [J]. Advanced Ultrasound in Diagnosis and Therapy, 2023, 7(3): 267-271.
[3]	Chang Liu, MD, Weiwei Shen, MD, Peng Fu, MD, Youchen Xia, MD, Jianxun Ma, MD, Ligang Cui, MD, Shi Tan, MD. Contrast-Enhanced Ultrasound in the Detection and Evaluation of Maxillofacial Arteriovenous Malformation: A Case Report [J]. Advanced Ultrasound in Diagnosis and Therapy, 2023, 7(3): 288-292.
[4]	Huiyong Hu, MS, Hairong Wang, MS, Yunfeng Xu, MS. Spontaneous Remission of Pediatric Undescended Testis Torsion during Color Doppler Ultrasound Examination [J]. Advanced Ultrasound in Diagnosis and Therapy, 2023, 7(3): 296-298.
[5]	Enze Qu, MD, Xinling Zhang, MD. Advanced Application of Artificial Intelligence for Pelvic Floor Ultrasound in Diagnosis and Treatment [J]. Advanced Ultrasound in Diagnosis and Therapy, 2023, 7(2): 114-121.
[6]	Rui Chen, MM, Fangqi Guo, MM, Jia Guo, MD, Jiaqi Zhao, MD. Application and Prospect of AI and ABVS-based in Breast Ultrasound Diagnosis [J]. Advanced Ultrasound in Diagnosis and Therapy, 2023, 7(2): 130-135.
[7]	Shujun Xia, MD, Jianqiao Zhou, MD. Ultrasound Image Generation and Modality Conversion Based on Deep Learning [J]. Advanced Ultrasound in Diagnosis and Therapy, 2023, 7(2): 136-139.
[8]	Cancan Cui, MD, Zhaojun Li, PhD, Yanping Lin, PhD. Advances in Intelligent Segmentation and 3D/4D Reconstruction of Carotid Ultrasound Imaging [J]. Advanced Ultrasound in Diagnosis and Therapy, 2023, 7(2): 140-151.
[9]	Wenjun Zhang, MD, Mi Zhou, PhD, Qingguo Meng, MD, Lin Zhang, MS, Xin Liu, MS, Paul Liu, PhD, Dong Liu, PhD. Rapid Screening of Carotid Plaque in Cloud Handheld Ultrasound System Based on 5G and AI Technology [J]. Advanced Ultrasound in Diagnosis and Therapy, 2023, 7(2): 152-157.
[10]	Jiaojiao Ma, MD, Xinying Jia, MD, Guanghan Li, MD, Dandan Guo, MD, Xuehua Xi, MD, Tongtong Zhou, MD, Ji-Bin Liu, MD, Bo Zhang, MD. Development of 5G-based Remote Ultrasound Education: Current Status and Future Trends [J]. Advanced Ultrasound in Diagnosis and Therapy, 2023, 7(2): 197-203.
[11]	Won-Chul Bang, PhD, Vice President, Yeong Kyeong Seong, PhD, Jinyong Lee. The Impact of Deep Learning on Ultrasound in Diagnosis and Therapy: Enhancing Clinical Decision Support, Workflow Efficiency, Quantification, Image Registration, and Real-time Assistance [J]. Advanced Ultrasound in Diagnosis and Therapy, 2023, 7(2): 204-216.
[12]	Siyi Xun, MA, Wei Ke, PhD, Mingfu Jiang, MA, Huachao Chen, BA, Haoming Chen, BA, Chantong Lam, PhD, Ligang Cui, MD, Tao Tan, PhD. Current Status, Prospect and Bottleneck of Ultrasound AI Development: A Systemic Review [J]. Advanced Ultrasound in Diagnosis and Therapy, 2023, 7(2): 61-72.
[13]	Rendong Chen, PhD, Xiaoqian Wang, BS, Ping Liang, MD, Xiaoping Ouyang, PhD, Dexing Kong, PhD. Intelligent Ultrasonic Diagnosis and Clinical Application: Technical Development and Prospectives [J]. Advanced Ultrasound in Diagnosis and Therapy, 2023, 7(2): 73-81.
[14]	Wenjia Guo, MM, Shengli Li, MM, Xing Yu, MD, Huaxuan Wen, BM, Ying Yuan, MM, Xia Yang, MM. Artificial Intelligence in Prenatal Ultrasound: Clinical Application and Prospect [J]. Advanced Ultrasound in Diagnosis and Therapy, 2023, 7(2): 82-90.
[15]	Changyan Wang, BS, Haobo Chen, MS, Jieyi Liu, BS, Changchun Li, BS, Weiwei Jiao, BS, Qihui Guo, BS, Qi Zhang, PhD. Deep Learning on Ultrasound Imaging for Breast Cancer Diagnosis and Treatment: Current Applications and Future Perspectives [J]. Advanced Ultrasound in Diagnosis and Therapy, 2023, 7(2): 91-113.