Biliary hamartomas as confounding factors in the noninvasive assessment of liver fibrosis

Abstract

Biliary hamartomas are benign hepatic malformations scattered throughout the parenchyma, which are usually asymptomatic. However, the diagnostic dilemmas they may cause justify the need for their thorough investigation. The aim of this article is to present the clinical case of a 55-year-old man with biliary hamartomas who was initially misdiagnosed with hepatic fibrosis based on elastography findings. For this purpose we used patient’s medical records, laboratory tests, imaging studies, and histopathological evaluations. The symptoms that led the patient to seek medical attention were very nonspecific: abdominal discomfort, bloating, and general fatigue. Paraclinical assessments remained inconclusive for a long time, suggesting progressive liver fibrosis. However, histopathological examination of hepatic tissue revealed no signs of fibrosis but confirmed the presence of biliary hamartomas, which were found to be the cause of the previous overestimation of fibrosis. Subsequently, contrast-enhanced magnetic resonance cholangiopancreatography was performed to assess the size (less than 4 mm) and hepatic distribution (segments VI and VIII) of the hamartomas. These findings allow us to conclude that biliary hamartomas are small hepatic lesions that rarely have a significant impact on the patient’s health, but their identification can be challenging due to the nonspecific clinical presentation and equivocal imaging features. Once diagnosed, careful monitoring is essential due to the potential risk of malignant transformation.