A phrygian cap

Fetal "Phrygian Cap" Gallbladder: Malformation or Deformation?

A series of five fetuses with a Phrygian cap gallbladder, a condition infrequently reported in the antenatal period, is reported. In all cases, examination of the fetal gallbladder displayed the characteristic folding of the fundus over the body. No associated findings were detected. The gallbladder length was longer than normal in all cases, suggesting that this anomaly could represent a deformity rather than a primary malformation. This might be caused by excessive longitudinal growth of the gallbladder, eventually folding after the fundus reaches the anterior border of the liver and is then diverted laterally by the abdominal wall.

Imaging patterns of wall thickening type of gallbladder cancer

Gallbladder cancer (GBC) has a high incidence in certain geographical regions. Morphologically, GBC presents as a mass replacing the gallbladder, a polypoidal lesion, or wall thickening. The incidence of preoperative diagnosis of wall thickening type of GBC is less well studied. The patterns of mural involvement and extramural spread are not well described in the literature. Additionally, wall thickening in the gallbladder does not always indicate malignancy and can be secondary to inflammatory or benign gallbladder diseases and extracholecystic causes and systemic pathologies. Objective reporting of gallbladder wall thickening will help us appreciate GBC's early features. In this review, we illustrate the imaging patterns of wall thickening type of GBC.

[Incidental and "leave me alone" findings of abdominal organs-part 1 : Liver, gall ducts and pancreas]

Incidentalomas of the parenchymal organs of the abdomen, i.e. radiological findings in these organs that are not the primary focus of the clinical question, are frequent in this region of the body. In particular, findings presumed to be unimportant, such as cystic masses in the liver, the bile duct system or the pancreas, initially appear to be irrelevant in the diagnosis. For the liver we define the mostly clearly diagnosable simple cysts and hemangiomas as leave me alone lesions. Otherwise, we recommend a classification of incidentalomas into the three major categories (<0.5 cm, 0.5-1.5 cm and >1.5 cm) as well as an assessment with respect to clearly benign and suspect imaging characteristics in the context of a classification of patients into three different risk groups.

Successful Surgical Management of Unusual Gallbladder Anatomy Through Laparoscopic Cholecystectomy of Ectopic Gallbladder

Abnormalities in the position of the gallbladder are not encountered commonly such as the ectopic location. We present a case of laparoscopic cholecystectomy for gallbladder that was found in an ectopic position. The surgical procedure can be difficult in some cases of acute cholecystitis and ectopic position of the gallbladder may add to complexities of the procedure due to abnormal location or anatomical variants of the biliary tree. Preoperative identification of ectopic gallbladder may aid in planning and performing a safe surgical procedure.

Risk of Gallstone Formation in Aberrant Extrahepatic Biliary Tract Anatomy: A Review of Literature

The age-long mnemonic of '5Fs' (fat, female, fertile, forty, and fair) has traditionally been used in medical school instructions to describe the risk factors for gallstone disease. However, evidence suggests that aberrant extrahepatic biliary tract (EHBT) anatomy may contribute significantly to the risk of gallstone disease. This review explores the anatomy and embryological bases of EHBT variations as well as the prevalence of these variations. Also, we discuss the risk factors for gallstone formation in the relationship between gallstone disease and aberrant EHBT anatomy.

Pseudo-duplication of the Gallbladder

Phrygian cap and its rare relative, pseudo-duplication of the gallbladder, are two radiologic findings that may be revealed on ultrasound evaluation. Correct identification of Phrygian cap and pseudo-duplication should trigger a careful survey of the gallbladder in its entirety to rule out pathology. These anatomic variants may lead to partial under-distension of the gallbladder and can cause the gallbladder wall to appear falsely thickened. Asymptomatic patients with this finding may be safely discharged while symptomatic patients may require further surgical consultation.

Double pouched, sigmoid gallbladder that can cause a diagnostic dilemma to radiologists: a case report

Gallbladder shows frequent variations in position, shape, interior, and its duct system. These variations may go unnoticed lifelong; however, they may predispose it for cholecystitis and cholelithiasis. We observed a double pouched gallbladder in an adult male cadaver. The gallbladder was folded to have a sigmoid shape. It had two broad pouches: anterior and posterior and a narrow isthmus in between. Its anterior pouch was covered by peritoneum, whereas the posterior pouch was covered by extrahepatic connective tissue. We discuss the clinical and radiological importance of the case.

Ectopic liver and gallbladder in a cloned dog: Possible nonheritable anomaly

Ectopic liver and gallbladder are rare anomalies usually not accompanied by any symptoms and are found during surgical exploration or autopsy. We aimed to find a cause of this anomaly using somatic cell nuclear transfer (SCNT) technology, which can produce genetically identical organisms. A cloned beagle having ectopic organs was produced and died on the day of birth. Major and ectopic organs were fixed and underwent histologic analysis. SCNT was performed using cells derived from the dead puppy to produce reclones. Normality of internal organs in the original donor dog and recloned dogs was evaluated by computed tomography. While a liver without the gallbladder was located in the abdominal cavity of the cloned dog, a well-defined, reddish brown mass with a small sac was also positioned outside of the thoracic cavity. Histologically, they presented as normal liver and gallbladder. Five reclones were produced, and computed tomography results revealed that the original donor dog and reclones had normal liver and gallbladder structure and location. This is the first report of both ectopic liver and gallbladder in an organism and investigation on the etiology of these abnormalities. Normal organ structure and position in the original donor dog and reclones suggests that the ectopic liver and gallbladder is a possible nonheritable anomaly.

Congenital bilobed gallbladder with phrygian cap presenting as calculus cholecystitis

The incidence of congenital bilobed gall bladder is 1 in 3000 to 4000. A Phrygian cap is a congenital abnormality of the gallbladder with an incidence of 4%. Preferred mode of diagnosis for Phrygian cap is cholescintigraphy and multi phase MRI, as Ultrasonography and CT are not always conclusive. The estimated prevalence of gallstone disease in India has been reported as 2% to 29%. A case of bilobed gall bladder with Phrygian cap in both the lobes and pigment gallstone in one of the lobes presenting as calculus cholecystitis is reported for its rarity and difficulty in arriving at correct preoperaive diagnosis.

Two congenital anomalies in one: an ectopic gallbladder with phrygian cap deformity

The gallbladder is affected by a large number of congenital anomalies, which may affect its location, number, size, or form. Some of these malformations are very rare and may lead to misdiagnosis. An ectopic gallbladder can be misinterpreted as agenesis of the organ or as a cystic hepatic mass when intrahepatic. Given the frequency and the wide acceptance of the ultrasonographic examination of the biliary tract, radiologists should be aware of these malformations. In some cases, ultrasonographic diagnosis can be difficult. However, the use of Computed Tomography can elucidate such cases. We present the case of a patient whose gallbladder had two combined malformations but caused no symptoms. Namely, the patient had a transverse ectopic gallbladder combined with a "Phrygian cap" deformity. The incidence of ectopic locations of the gallbladder is 0.1-0.7%, whereas the "Phrygian cap" deformity can be found in 4% of patients. There is no other cases with combination of these two entities reported in the literature. Ultrasonographic and CT findings are presented and aspects of this malformation are discussed. The clinical significance of ectopic gallbladder is also emphasized because it may alter the clinical presentation of biliary tract diseases and pose technical problems during surgery.