Differential Diagnosis for Branching Round or Tubular Peripherally Enhancing Tiny Hypodensities along the Biliary Radicles in Liver in a Toddler

• Single Most Likely Diagnosis
  • Biliary atresia: This condition is characterized by a blockage or absence of the bile ducts, leading to cirrhosis and liver damage. The described imaging findings could represent the dilated biliary radicles that are often seen in this condition.
• Other Likely Diagnoses
  • Choledochal cysts: These are congenital anomalies of the bile ducts that can cause dilatation and may appear as round or tubular structures along the biliary radicles on imaging.
  • Caroli's disease: A rare congenital disorder involving non-obstructive dilatation of the intrahepatic bile ducts, which could present with similar imaging findings.
• Do Not Miss Diagnoses
  • Biliary rhabdomyosarcoma: Although rare, this malignant tumor can present with biliary obstruction and could potentially cause the described imaging findings. It is crucial to consider due to its severe prognosis if missed.
  • Invasive fungal infections (e.g., aspergillosis): In immunocompromised patients, fungal infections can cause microabscesses that might appear as tiny hypodensities, and their diagnosis is critical due to the high mortality rate if left untreated.
• Rare Diagnoses
  • Polycystic liver disease: While more commonly associated with larger cysts, some variants could potentially present with smaller, more numerous cysts that might mimic the described findings.
  • Biliary hamartomas (von Meyenburg complexes): These are benign lesions that could appear as small, hypodense lesions but are typically not peripherally enhancing and are less likely to cause the described pattern of enhancement along the biliary radicles.