A 6-year-old girl presents with intermittent jaundice, right upper quadrant pain, and a palpable cystic mass. Ultrasound shows fusiform dilatation of the extrahepatic bile duct together with cystic dilatation of the intrahepatic ducts. According to the Todani classification, this anomaly is type:

• A Type I
• B Type II
• C Type III
• D Type IVA ✓

Explanation

Todani type IVA denotes cystic dilatation of both the intrahepatic and extrahepatic bile ducts, which matches this child's imaging. Type I is dilatation confined to the extrahepatic duct, the commonest variety. Type II is a true diverticulum of the supraduodenal duct, and type III is a choledochocele confined to the intraduodenal portion of the duct. Complete excision of the cyst with Roux-en-Y hepaticojejunostomy is the definitive treatment because of the risk of cholangiocarcinoma.

Reference: Bailey and Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.