0:01

So this patient's an 80-year-old female

0:03

history is to evaluate for a pancreatic mass.

0:07

I'm sure we're going to ignore the

0:08

pancreas, ignore everything else.

0:10

We're going to focus just on the liver.

0:12

As we scroll downwards, we're

0:14

seeing numerous tiny liver cysts.

0:20

Right?

0:21

They're everywhere, sort of scattered

0:24

throughout the liver, all the

0:26

hepatic lobes; let's zoom in on them.

0:28

And I think one of the things that is

0:30

important to notice is when I said they

0:31

were tiny, they're very, very small.

0:33

If you were to measure any of

0:34

these, I doubt you would get above a

0:37

centimeter, maybe a centimeter at most.

0:39

Most of these are much less than that.

0:41

And most are probably about

0:42

five millimeters or less.

0:43

And they're sort of scattered

0:44

everywhere throughout the liver.

0:47

Look at our coronal T2-weighted

0:48

image; it shows you the same finding.

0:50

Numerous, innumerable even; you can't

0:52

even count them, there's so many cysts

0:54

that are scattered throughout the liver.

0:57

We gave contrast; these behave like cysts.

1:01

These will not enhance, really dark

1:03

circles that are sort of littered

1:05

throughout the liver parenchyma.

1:07

Now, I must say, this in and of itself

1:09

is sort of a nonspecific finding, right?

1:11

You can just say that the patient

1:12

happens to have numerous liver cysts.

1:14

So which happened to be very

1:15

tiny and, and let it be like that.

1:17

But when you see so many liver cysts

1:20

like this, that are all very, very small,

1:22

certainly, you know, less than 10 millimeters,

1:24

certainly less than 15 millimeters.

1:26

One of the things you want to think about

1:27

is this entity of biliary hematomas.

1:31

These are also known as von Mayenberg complexes.

1:35

It's a finding that's thought to be congenital.

1:38

Histologically, what they find is that these

1:41

represent very small noncommunicating ducts

1:44

that are embedded inside a dense fibrous stroma.

1:48

What you need to know is that they are almost

1:50

always asymptomatic, almost always incidental,

1:53

really have very little to no clinical

1:56

significance, except for the fact that you

1:59

should just know what they are and you can

2:01

suggest it and know how to differentiate

2:02

these from other entities that can give, you

2:05

know, liver cysts such as Caroli's disease or

2:07

autosomal dominant polycystic kidney disease.

2:10

And what really differentiates this

2:11

from those other entities is the

2:13

fact that the cysts are very small.

2:16

As I said, almost all of them are

2:17

less than 15 millimeters, but in

2:19

reality even a lot smaller than that.

2:21

And the patient is otherwise healthy.

2:23

Lab values are good and no issues that

2:25

are related, uh, you know, in terms

2:26

of abnormal liver function tests.

2:28

And so, I thought this was just a nice

2:30

example of these biliary hematomas,

2:33

also known as von Mayenberg complexes.