PMC5490844_01
(a) Sagittal ultrasonographic image of the right liver of case 1. The largest biliary structure represents the segmentally dilated common bile duct (CBD; arrow) with mild wall thickening. There is a collection of organized, dependent echogenic debris within the CBD dilatation. The tubular structure noted ventral to the CBD represents a dilated extrahepatic duct containing echogenic bile (asterisk). (b) Sagittal image of the gall bladder and CBD at follow-up ultrasound examination 27 months postoperatively. The CBD focal dilatation is absent and the distal CBD measures 3.4 mm in diameter (calipers).
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There was a single, large (~1.7 cm diameter x 3.0 cm length), smoothly margined, fusiform, segmental dilatation of the proximal to mid-aspect of the CBD (Figure 1a). There was no recurrence of CBD dilatation (Figure 1b) and there was resolution of the previous intrahepatic duct dilatation.
PMC5490844_02
(a) Sonogram of the right liver of case 2. Multiple dilated bile ducts are visible, including extrahepatic (arrowhead) and intrahepatic ducts (asterisk). There is variable echogenic-dependent debris in the visible intrahepatic bile ducts. The structure in the far field is the proximal aspect of the common bile duct dilatation (arrow). (b) Post-mortem image of the liver of case 2. The extrahepatic bile ducts (arrows) are severely, irregularly dilated and the hepatic capsular surface is multifocally deformed by irregularly dilated intrahepatic bile ducts (asterisk).
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There was marked, irregularly fusiform dilatation of the proximal CBD (Figure 2a) with a concurrent, focal, rounded, cystic dilatation of the distal aspect of the CBD measuring 5.2 cm in diameter. On post-mortem examination, the abdomen was filled by numerous, coalescing, cystic dilatations of the external biliary tree up to approximately 6.0 cm in diameter (Figure 2b).
PMC5490844_03
Transverse sonogram of the segmental common bile duct (CBD) dilatation in case 3 (arrow). There are dependent, shadowing calculi (asterisk) within a saccular, dilated extrahepatic bile duct adjacent to the CBD (arrowhead). A small intestinal segment can be seen in the near-field; there is evidence of wall thickening (up to 4.5 mm) with thickening of the muscularis layer (cross).
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There was a single, large (approximately 2.4 cm diameter x 3.7 cm length), fusiform, focal dilatation of the distal aspect of the CBD (Figure 3).
PMC5490844_04
(a) Sagittal and (b) transverse sonograms of the right liver of case 4. There is a fusiform focal dilatation of the proximal aspect of the common bile duct (arrow). Dilated extrahepatic ducts can be seen coalescing with the focal dilatation of the common bile duct (CBD; arrowhead). In the near field there is a dilated intrahepatic bile duct (asterisk). Echogenic, dependent sediment is present in the CBD and the intrahepatic duct.
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There was a large (approximately 3.2 cm diameter x 5.0 cm length), fusiform, focal dilatation of the proximal aspect of the CBD (Figures 4a,b).