Todani Classification of Choledochal Cysts

Todani Classification of Choledochal Cysts

classification and cross sectional imaging features of choledochal cysts

Choledochal cysts are congenital cystic dilations of the bile ducts, with the vast majority presenting in childhood, more commonly seen in women than in men. These are divided into 5 subtypes as per the Todani Classification. 

The below table details the classification and imaging findings. It is important to recognize, and potentially surgically resect, choledochal cysts, given the increased risk of recurrent ascending cholangitis, calculus formation, and cholangiocarcinoma. In types I through V, focal or multifocal dilation of the bile ducts is seen, sometimes with presence of intraductal calculi. In type V, the “central dot” sign may also be encountered, which appears within the liver as an enhancing portal venous radicle surrounded by dilated bile duct radicles.

Todani Classification of Choledochal Cysts

I(a-c)Diffuse or segmental fusiform dilation of extrahepatic bile ductMost common type (80% to 90%)
IISaccular bile duct diverticulumRare type (2%)
IIIFocal dilation of intramural segment of distal CBD in 2nd portion of duodenumAlso known as a choledochocele, uncommon type (5%)
IVaMultifocal dilation of intrahepatic and extrahepatic bile ductsSecond most common type (10%)
IVbMultifocal dilation of extrahepatic bile ducts
VMultifocal dilation of intrahepatic bile ductsAlso known as Caroli’s disease, rare type; may be associated with congenital hepatic fibrosis, medullary sponge kidney, and cystic renal disease

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