Starry Sky” Appearance from Multiple Biliary Hamartomas
A 45-year-old woman was referred to the outpatient clinic after multiple hepatic lesions were incidentally noted on imaging. She 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. Enhanced computed tomography of the abdomen showed multiple small, hypodense, nonenhancing nodules throughout the liver (Panel A). Magnetic resonance imaging with cholangiopancreatography revealed multiple small, T2-weighted, hyperintense cystic nodules in the liver, with no biliary duct communication, creating a “starry sky” appearance (Panel B). These 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.