Question

The clinical features of a choledochal cyst in an adult are:

• A. Pain, lump and intermittent jaundice
• B. Pain, fever and progressive jaundice
• C. Pain, lump and progressive jaundice
• D. Pain, fever and progressive jaundice

Hint:

Think about how the jaundice pattern differs between children and adults with this condition.

Answer 1

The Correct Option is C

Step 1: Understanding the Question:
The question asks how a choledochal cyst typically presents specifically in an adult, as opposed to a child.

Step 2: Key Concept or Approach:
The classic teaching triad of pain, jaundice, and a palpable abdominal mass is described mainly in children, though the full triad is actually seen in only a minority of cases. In adults, the presentation differs: cyst enlargement together with distal stricture or sludge tends to cause progressive, steadily worsening jaundice rather than the fluctuating, intermittent jaundice seen in children, and a palpable right-upper-quadrant lump remains a recognized feature, especially with fusiform (type I) cysts. Adults with choledochal cysts are also prone to complications such as recurrent cholangitis, stone formation, and pancreatitis over time, but the basic presenting triad tested here is pain, lump, and progressive jaundice.

Step 3: Working Through the Options:
"Pain, lump and intermittent jaundice" describes the childhood pattern, where jaundice fluctuates with biliary flow through the cyst. "Pain, fever and progressive jaundice" foregrounds fever, which points to superimposed cholangitis, a complication rather than the core presenting picture. "Pain, lump and progressive jaundice" correctly captures the adult pattern, where a mass is often palpable and jaundice worsens steadily as the cyst and any associated stricture progress. The repeated fourth option mirrors the second and does not change this reasoning.

Step 4: Conclusion:
The clinical features in an adult are pain, lump and progressive jaundice.