Multiple Biliary Hamartomas in a Patient With Liver Cirrhosis

Abstract

Multiple biliary hamartomas or Von Myenburg complexes are very rare hamartomatous nodules of the liver which were first described in 2005. Till date, there are around ten case reports in literature mostly from Eastern patient populations without underlying hepatic cirrhosis. We present a unique case of biliary hamartomas in a middle aged Hispanic Male also found to have co-existing Liver Cirrhosis. 57 year old Hispanic Male with past medical history of hypertension presented with complaint of intermittent fever and chills for one week more pronounced at night time. He also had associated cough productive of pinkish sputum, periodic headaches and occasional abdominal discomfort. He denied any shortness of breath, chest pain, vomiting, weight loss, recent travel and sick contacts. His only medication was Amlodipine and he denied any history of smoking, alcohol use, intravenous drug use, hepatitis or blood transfusions. He worked as a bus driver and denied family history of malignancies. In emergency room, patient was found to have a temperature of 103 degrees Fahrenheit. Physical examination was only remarkable for crackles at bilateral lung bases. Initial chest X-ray did not reveal any abnormalities and an abdominal CT was done for further evaluation which showed cirrhotic hepatic morphology with innumerable low density lesions including 4 centimeter low density area in left hepatic lobe raising suspicion for underlying malignancy. During the hospitalization, he became short of breath and CT chest done at that time revealed bilateral opacities and his persistent fevers were attributed to possible community acquired pneumonia which was treated with empiric antibiotics. His hepatitis profile, liver enzymes and ceruloplasmin levels were normal. MRI of abdomen was done for further evaluation of hepatic lesions which revealed multiple biliary hamartomas or myenberg complexes with hepatic cirrhosis. Subsequently his fever subsided and clinical condition improved. Patient was advised to follow up as outpatient with repeat imaging to assess the hamartomas in few months. Biliary Hamartomas are rare hamartomatous nodules of liver which are frequently multiple round or irregular lesions scattered throughout the liver. In most cases they are found incidentally and often confused with underlying malignancy or metastatic lesions. Specific CT and MRI characteristics of these lesions make these imaging modalities useful in making the diagnosis. Although the natural progression and optimal management remains uncertain, most available literature suggests a benign course of these lesions. Careful outpatient monitoring and follow-up of the lesions is considered appropriate at this time. Association with liver cirrhosis needs to be determined based on further research and case reports as limited data is available at present.Figure 1Figure 2