Answer to the last #DiagnosticDilemma
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The answer to the last Diagnostic Dilemma (A 45-year-old woman with multiple hepatic lesions incidentally noted on imaging. Magnetic resonance imaging with cholangiopancreatography revealed multiple small, T2-weighted, hyperintense cystic nodules in the liver, without biliary duct communication, creating a “starry sky” appearance) is Multiple biliary hamartomas.

The patient had no related symptoms, and the physical examination was normal. Laboratory tests showed no liver dysfunction, with normal levels of alanine aminotransferase, alkaline phosphatase, and bilirubin and a normal international normalized ratio. The MRI and CT findings were consistent with biliary hamartomas, benign malformations of the intrahepatic biliary ducts. No specific treatment was initiated, and at a follow-up visit 2 years after presentation, the imaging findings were unchanged.

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Source: NEJM
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