IMAGE OF THE ISSUE Cobra-head choledochocele: depiction with computed tomography and cholangiogram Ankur Arora 1 , Abhay Kapoor 2 & Sunil Kumar Puri 2 1 Department of Radiodiagnosis, Institute of Liver & Biliary Sciences, and 2 Department of Radiodiagnosis, GB Pant Hospital, New Delhi, India Received 15 February 2012; accepted 20 February 2012 Correspondence Ankur Arora, Department of Radiodiagnosis, Institute of Liver & Biliary Sciences, D-1 Vasant Kunj, New Delhi-110070, India. Tel.: +91 9873030114. Fax: +91 11 23411385. E-mail: [email protected] A 35-year old male with acute cholecystitis and septic cholangitis underwent an open cholecystectomy before referral. Subsequent contrast-enhanced CT showed a cystic intra-duodenal lesion at the ampulla of Vater (Fig. 1a) and a T-tube cholangiogram showed a lower common bile duct ovoid ﬁlling defect protruding into the duodenum giving a characteristic ‘cobra-head’ appearance suggestive of Type-III choledochocele. There was also an intra-luminal calculus seen as a ﬁlling defect (arrow) (Fig. 1b). A Type-III choledochal cyst is one of the most infrequent subtypes of choledochal cysts, constituting 1–5% of all cases. 1 Type IIIa represents an intraluminal choledochocoele in the duodenum that contains the terminal pancreatic as well as the common bile duct as a common channel; Type IIIb contains a separate pancreatic and a common duct within an intraluminal cyst; and Type IIIc shows a completely intramural cyst within the duodenal wall. 2 References 1. De Backer AI, Van den Abbeele K, De Schepper AM, Van Baarle A. (2000) Choledochocele: diagnosis by magnetic resonance imaging. Abdom Imaging 25:508–510. 2. Greene FL, Brown JJ, Rubinstein P, Anderson MC. (1985) Choledochocele and recurrent pancreatitis. Diagnosis and surgical management. Am J Surg 149:306–309. Figure 1 Contrast-enhanced CT scan reveals cystic lesion protruding into the second part of duodenum in the region of ampulla (arrow). T-tube cholangiogram displays a bulbous dilatation of the distal common bile duct (arrow), which protrudes into the duodenum giving rise to a ‘cobra-head’ appearance. Intra-luminal calculus is seen as an ovoid filling defect DOI:10.1111/j.1477-2574.2012.00459.x HPB HPB 2012, 14, 422 © 2012 International Hepato-Pancreato-Biliary Association

Cobra-head choledochocele: depiction with computed tomography and cholangiogram

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Page 1: Cobra-head choledochocele: depiction with computed tomography and cholangiogram

IMAGE OF THE ISSUE

Cobra-head choledochocele: depiction with computed tomographyand cholangiogramAnkur Arora1, Abhay Kapoor2 & Sunil Kumar Puri2

1Department of Radiodiagnosis, Institute of Liver & Biliary Sciences, and 2Department of Radiodiagnosis, GB Pant Hospital, New Delhi, India

Received 15 February 2012; accepted 20 February 2012

CorrespondenceAnkur Arora, Department of Radiodiagnosis, Institute of Liver & Biliary Sciences, D-1 Vasant Kunj, New Delhi-110070, India. Tel.: +91

9873030114. Fax: +91 11 23411385. E-mail: [email protected]

A 35-year old male with acute cholecystitis and septic cholangitisunderwent an open cholecystectomy before referral. Subsequentcontrast-enhanced CT showed a cystic intra-duodenal lesion atthe ampulla of Vater (Fig. 1a) and a T-tube cholangiogramshowed a lower common bile duct ovoid filling defect protrudinginto the duodenum giving a characteristic ‘cobra-head’ appear-ance suggestive of Type-III choledochocele. There was also anintra-luminal calculus seen as a filling defect (arrow) (Fig. 1b).

A Type-III choledochal cyst is one of the most infrequentsubtypes of choledochal cysts, constituting 1–5% of all cases.1

Type IIIa represents an intraluminal choledochocoele in theduodenum that contains the terminal pancreatic as well as the

common bile duct as a common channel; Type IIIb contains aseparate pancreatic and a common duct within an intraluminalcyst; and Type IIIc shows a completely intramural cyst within theduodenal wall.2

References

1. De Backer AI, Van den Abbeele K, De Schepper AM, Van Baarle A. (2000)

Choledochocele: diagnosis by magnetic resonance imaging. Abdom

Imaging 25:508–510.

2. Greene FL, Brown JJ, Rubinstein P, Anderson MC. (1985) Choledochocele

and recurrent pancreatitis. Diagnosis and surgical management. Am J Surg

149:306–309.

Figure 1 Contrast-enhanced CT scan reveals cystic lesion protruding into the second part of duodenum in the region of ampulla (arrow).T-tube cholangiogram displays a bulbous dilatation of the distal common bile duct (arrow), which protrudes into the duodenum giving riseto a ‘cobra-head’ appearance. Intra-luminal calculus is seen as an ovoid filling defect

DOI:10.1111/j.1477-2574.2012.00459.x HPB