Multiple biliary micro-hamartomas diagnosed in an unsuspecting elderly patient

BACKGROUND AND AIM: Multiple biliary hamartomas are a benign incidental finding in the hepatic context. Recognizing them is not easy if one has never seen them and does not have access to the right imagery. The aim of the study is to expand the radiologist's digital image library, enabling a quick and precise differential diagnosis. Indeed, multiple biliary hamartomas can be challenging to differentiate from other liver lesions based on imaging alone. This case highlights the importance of thorough radiological assessment and the need for a multidisciplinary approach, involving radiologists, hepatologists, and pathologists, to ensure a precise diagnosis. METHODS: The patient in the study presented at the hospital for a CT scan and after an abdominal MRI recommended by his general practitioner to assess the biliary tree (Magnetic Resonance Cholangiopancreatography, MRCP) due to persistent abdominal pain. They had never undergone an abdominal MRI before in their life. The discovery of hepatic lesions was incidental and unexpected RESULTS: The MRI investigation revealed multiple benign lesions in both hepatic lobes compatible with the von Meyenburg complex. These lesions are multiple hamartomas and behave differently in all MRI sequences. CONCLUSIONS: The images acquired with the different MRI sequences were carefully examined. Despite being multiple and scattered throughout the liver, the lesions appeared immediately benign and consistent with the incidental diagnosis of multiple biliary hamartomas. Medical practitioners should be aware of the existence of multiple biliary hamartomas and consider them in the differential diagnosis when patients present with hepatic abnormalities. This knowledge can prevent unnecessary interventions and guide appropriate patient management.