Imaging of benign biliary pathologies

Abdom Radiol (NY). 2023 Jan;48(1):106-126. doi: 10.1007/s00261-022-03440-5. Epub 2022 Feb 24.


Pathologies of the biliary tree include a wide-spectrum of benign and malignant processes. The differential for benign disease includes congenital and acquired disease with variable prognosis and management pathways. Given the ability to mimic malignancy, benign processes are difficult to diagnose by imaging. Direct cholangiography techniques with tissue sampling are the gold standards for the diagnosis of benign and malignant biliary pathologies. Non-invasive imaging with ultrasound offers a first-line diagnostic tool while MRI/MRCP offers higher specificity for identifying underlying pathology and distinguishing from malignant disease. In this review, we focus on the imaging appearance of dilatation, cystic anomalies obstruction, inflammation, ischemia, strictures, pneumobilia, and hemobilia to help construct a differential for benign processes.

Keywords: Biliary; Choledocholithiasis; Hemobilia; Pneumobilia; Strictures.

Publication types

  • Review

MeSH terms

  • Biliary Tract Diseases* / diagnostic imaging
  • Biliary Tract*
  • Cholangiography / methods
  • Cholangiopancreatography, Endoscopic Retrograde / methods
  • Humans
  • Magnetic Resonance Imaging / methods
  • Sensitivity and Specificity
  • Ultrasonography