Extensive Von Meyenburg Complexes Mimicking Diffuse Hepatic Metastases: Diagnostic Role of MRI and Magnetic Resonance Cholangiopancreatography.

Von Meyenburg complexes (VMCs), also known as biliary hamartomas, are benign ductal plate malformations that are frequently identified incidentally on imaging. When numerous and diffusely distributed throughout the liver, they may mimic metastatic disease and create significant diagnostic uncertainty.  We report the case of a woman in her fifties who presented with abdominal pain and underwent contrast-enhanced computed tomography (CT), which demonstrated multiple low-attenuation lesions throughout both hepatic lobes. This distribution pattern raised concern for diffuse hepatic metastatic disease despite the absence of a known primary malignancy. Subsequent magnetic resonance cholangiopancreatography (MRCP) demonstrated innumerable subcentimetre T2-hyperintense lesions scattered throughout both hepatic lobes, without communication with the biliary tree, a dominant hepatic mass, or suspicious solid components. These appearances were characteristic of von Meyenburg complexes and inconsistent with diffuse metastatic disease. The case was reviewed at an Upper Gastrointestinal Multidisciplinary Team (UGI MDT) meeting, where the lesions were considered benign and no further invasive investigation was required. This case highlights the importance of recognising the characteristic MRI features of VMCs. Accurate radiological diagnosis can facilitate confident non-invasive diagnosis, avoid unnecessary invasive procedures and inappropriate oncological referral, and reduce anxiety associated with a suspected diagnosis of metastatic malignancy.