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Vol. 86. Issue 2.
Pages 191-192 (April - June 2021)
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Vol. 86. Issue 2.
Pages 191-192 (April - June 2021)
Clinical image in Gastroenterology
DOI: 10.1016/j.rgmxen.2020.08.002
Open Access
Multiple biliary hamartomatosis: «Starry sky» image
Hamartomatosis biliar múltiple: «imagen en cielo estrellado»
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M. Bravo-Acostaa,
Corresponding author
mariolgabravo@gmail.com

Corresponding author at: Médico especialista en Medicina Interna y Neumología, Servicio de Medicina Interna, Hospital General Guasmo Sur, Guayaquil, Ecuador.
, J. Rosendo-Namíasb, D. Martínez-Méndezc
a Servicio de Medicina Interna, Hospital General Guasmo Sur, Guayaquil, Ecuador
b Servicio de Medicina Interna y Cirugía, Hospital Provincial de Ovalle «Dr. Antonio Tirado Lanas», Ovalle, Chile
c Malongo Clinic, Cabinda, Angola
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Multiple biliary hamartomas (MBHs), or the von Meyenburg complexes, are cystic malformations of the small interlobular bile ducts that arise from the cranial portion of an endodermal diverticulum during embryologic development. Prevalence is under 1%, with few cases described, and they can be confused with other cystic liver tumors. MBHs are generally asymptomatic and benign but can be associated with cholangiocarcinoma, thus CA 19-9 determination and lesion follow-up are recommended.

A 49-year-old woman with an unremarkable medical history, was asymptomatic and had normal liver function tests. She presented with multiple small liver lesions, with low attenuation, as an incidental finding on the upper abdominal axial projection of a chest computed tomography (CT) scan (Fig. 1). Abdominal magnetic resonance imaging (MRI) and magnetic resonance cholangiopancreatography (MRCP) identified numerous round lesions, 2×2mm to 15×12mm in diameter, hypointense on T1, hyperintense on T2, not communicating with the biliary tree (Fig. 2a and b). The lesions were evenly dispersed in both liver lobes, with a "starry sky" appearance (Fig. 3). Given the clinical characteristics and typical MR and MRCP images, the diagnosis of MBH was made. No histologic confirmation was requested.

Figure 1.

Computed tomography: Axial view of the upper abdomen showing multiple small, low-attenuation liver lesions.

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Figure 2.

Abdominal magnetic resonance imaging: Numerous round lesions, hypointense on T1 (2a) and hyperintense on T2 (2b).

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Figure 3.

Magnetic resonance cholangiopancreatography: Multiple small lesions evenly dispersed in both liver lobes, with a “starry sky” appearance.

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Ethical considerations

The authors declare that they followed the protocols regarding the publication of patient data, guaranteeing anonymity, and that none of the images or text includes data that could identify the patient.

The authors declare that even though no personal data that could identify the patient were published in the present article, informed consent was obtained from the patient, and the document is in the possession of the corresponding author.

Financial disclosure

No financial support was received in relation to this article.

Conflict of interest

The authors declare that there is no conflict of interest.

Please cite this article as: Bravo-Acosta M, Rosendo-Namías J, Martínez-Méndez D. Hamartomatosis biliar múltiple: «imagen en cielo estrellado». Revista de Gastroenterología de México. 2021;86:191–192.

Copyright © 2020. Asociación Mexicana de Gastroenterología
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