A Starry Sky in the Liver

A 45-year-old woman has multiple liver lesions found on imaging. CT and MRI show a “starry sky” appearance. What is the diagnosis for these benign findings?

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. The physical examination and laboratory tests were all normal. Enhanced computed tomography of the abdomen had shown multiple small, hypodense, nonenhancing nodules throughout the liver. 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. What is the diagnosis?

What is the most likely diagnosis?

Acute hepatitis
Multiple biliary hamartomas
Malignant hydatidosis
Multiple liver metastases
Caroli syndrome

Incidentaloma, Liver lesions, Multiple biliary hamartomas, Starry sky appearance, Von Meyenburg complexes

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