Diagnostic Discordance-based Inferences Regarding Imaging Modalities in Children with a Preliminary Diagnosis of Choledochal Cyst: Clinical Experience and Review of Literature Koledok Kisti Ön Tanısı Konan Çocuklarda Görüntüleme Modalitelerine İlişkin Tanısal Uyumsuzluk Temelli Çıkarımlar: Klinik Deneyim ve Literatür Taraması
Guncel Pediatri, cilt.19, sa.2, ss.185-192, 2021 (ESCI, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 19 Sayı: 2
- Basım Tarihi: 2021
- Doi Numarası: 10.4274/jcp.2021.0024
- Dergi Adı: Guncel Pediatri
- Derginin Tarandığı İndeksler: Emerging Sources Citation Index (ESCI), Scopus, Academic Search Premier, CAB Abstracts, CINAHL, EMBASE, Veterinary Science Database
- Sayfa Sayıları: ss.185-192
- Anahtar Kelimeler: Choledochal cyst, magnetic resonance cholangiopancreatography, MRCP, intraoperative cholangiography, IOC
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Introduction: Definitive diagnosis is essential for the medical and surgical management of pediatric patients with a preliminary diagnosis of a choledochal cyst. Our study aimed to investigate the roles of Magnetic Resonance Cholangiopancreatography (MRCP), Intraoperative Cholangiography (IOC) in differential and definitive diagnosis of choledochal cyst by comparing their results with the intraoperative gross pathological appearance. Materials and Methods: The medical records of seven pediatric patients preliminary diagnosed with choledochal cyst between May 2014 and January 2021 in our clinic, were retrospectively reviewed. We investigated the clinical characteristics, the MRCP and IOC results, and compared their results with the intraoperative gross pathological findings of patients with preliminarily diagnosed choledochal cyst. We evaluated the outcomes involving the preliminary diagnosis and subtype of choledochal cyst with MRCP preoperatively and with IOC and gross pathological findings intraoperatively. Results: Six patients had undergone a laparotomy and IOC procedure, and their results were: in three, the MRCP and IOC results were consistent, both revealing a Type-I choledochal cyst; in another patient, MRCP revealed a Type-IV choledochal cyst, whereas IOC showed a Type-I choledochal cyst; one patient reported having a Type-II choledochal cyst in MRCP turned out to have a duodenal duplication cyst intraoperatively; the sixth operated patient had an MRCP result of Type-I choledochal cyst, but the IOC was consistent with biliary atresia and severe hydropic bile stasis. The last child was a non-operated patient whose MRCP revealed a Type-I choledochal cyst whereas contrast-enhanced liver magnetic resonance showed a simple liver cyst. Conclusions: Even though MRCP is valuable regarding choledochal cyst’s differential diagnosis, we should confirm its diagnosis by IOC and intraoperative gross pathological view because other pathologies might appear similar to choledochal cyst in MRCP.