Incidentally Detected Von Meyenburg Complexes on Ultrasonography: A Case Report

Abstract

Background: Von Meyenburg complexes (VMCs), or biliary hamartomas, are benign ductal plate malformations characterized by
multiple small cystic lesions within the hepatic parenchyma. They are usually asymptomatic and are often detected incidentally on
imaging. Although typically recognized on magnetic resonance imaging or computed tomography, characteristic ultrasonographic
appearances may provide an important clue to the diagnosis.
Case report: A 50-year-old woman presented with mild upper abdominal pain. Abdominal ultrasonography demonstrated a small
gallbladder calculus and multiple tiny echogenic foci diffusely distributed throughout the liver. Several lesions exhibited characteristic ring-down artifacts. The liver was normal in size, with no intrahepatic or extrahepatic biliary dilatation. The lesions showed no demonstrable communication with the biliary tree or internal vascularity on color Doppler examination. Contrast-enhanced computed tomography subsequently demonstrated a few tiny, well-defined hypodense lesions, predominantly in the right hepatic lobe, without appreciable contrast enhancement. Magnetic resonance imaging and liver biopsy were recommended for definitive characterization; however, the patient declined further investigations. Based on the characteristic sonographic findings, absence of biliary communication or significant clinical and biochemical abnormalities, and corresponding non-enhancing hypodense lesions on CT, a diagnosis of VMC was considered highly likely.
Conclusion: VMCs should be considered in the differential diagnosis of multiple tiny echogenic hepatic lesions, particularly when
associated with ring-down artifacts and characteristic clinical and imaging features. Recognition of this uncommon entity on
ultrasonography can help avoid unnecessary diagnostic procedures and facilitate appropriate further evaluation.

BJusg. vol. 27, no. 1, June 2026, Page: 79-82