Multiple biliary hamartoma - incidental finding

70 years old female. Presentation The patient presented with fever and abdominal pain. An ultrasound of the right upper quadrant showed fatty liver, cholelithiasis and perhaps a choledochal cyst. Clinically, she was not jaundiced and no palpable mass. Liver function tests were normal. MRI shows innumerable tiny lesions measuring up to 0.8 cm, scattered within both liver lobes. They appear hypointense on T1, hyperintense on T2 with no fat-suppression. They give a starry-sky appearance on the MRCP. No obvious communication of these lesions to the intrahepatic ducts. These lesions were not detectable on US. No choledochal cyst identified, instead a bilobed gallbladder with cholelithiasis are observed. Case Discussion Multiple biliary hamartomas which are also known as von Meyenburg complexes, are uncommon benign malformation of the biliary tree. This is often an incidental finding and the patient is asymptomatic. Different pattern on histology causes this entity to exhibit different features on US, whether hyper- or hypoechoic. Some may demonstrate comet-tail echo. Liver biopsy may be required in rare equivocal cases. Differential diagnosis includes choledochal cysts and liver metastases which requires IV gadolinium to differentiate them