EURORAD ESR

Case 14309

Pyloric-type gallbladder adenoma: ultrasound, CT and MRI findings

Author(s)
Tonolini Massimo, MD (1); Crespi Michele, MD (2); Matacena Giovanni, MD (1)

"Luigi Sacco" University Hospital, Radiology (1) and Surgery (2) Departments
Via G.B. Grassi 74 20157 Milan, Italy; Email:mtonolini@sirm.org
 
Patient
female, 39 year(s)
 
 
  • Figure 1
    Ultrasound
     

    Sonography showed a large (maximum diameter 3.6 cm) non-mobile homogeneous intraluminal mass (arrowheads), approximately isoechoic with the liver, overlying the continuous, non-thickened gallbladder wall (thin arrows).

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: Ultrasound; Procedure: Diagnostic procedure; Special Focus: Dysplasias;

    The gallbladder intraluminal mass (arrowheads) was seen overlying the continuous, non-thickened gallbladder wall (thin arrows), showed lobulated margins and appeared approximately isoechoic with the liver.

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: Ultrasound; Procedure: Diagnostic procedure; Special Focus: Dysplasias;
     
     
  • Figure 2
    Unenhanced and post-contrast multidetector CT
     

    The intraluminal gallbladder mass (arrowhead) overlying the non-thickened wall (thin arrow) showed solid attenuation values (28-30 Hounsfield units) on unenhanced scans. Note fatty liver, peripancreatic oedema (*).

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Dysplasias;

    Post-contrast images showed moderately vascularised gallbladder intraluminal mass (arrowheads) with vascular pedicle in the arterial-dominant (b,c) phase. Note continuous, normally enhancing gallbladder wall (thin...

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Dysplasias;

    Moderately vascularised intraluminal mass (arrowheads) with vascular pedicle in the arterial-dominant (b,c) phase. Note normal thickness and enhancement of gallbladder wall (thin arrows), duodenal lipoma (thick arrow)

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Dysplasias;

    Portal venous phase images (d,e) showed moderately enhancing intraluminal gallbladder mass (arrowheads) overlying the normal gallbladder wall (thin arrows). Note normal pancreatic enhancement, peripancreatic oedema (*).

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Dysplasias;

    Portal venous phase images (d,e) showed moderately enhancing intraluminal gallbladder mass (arrowheads) overlying the normal gallbladder wall (thin arrows). Note normal pancreatic enhancement, duodenal lipoma (thick...

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Dysplasias;
     
     
  • Figure 3
    MRI - T2-, Diffusion-weighted and MR cholangiopancreatography images
     

    T2-weighted images (a-b, fat-suppressed c) confirmed intraluminal gallbladder mass (arrowheads) with low signal intensity, overlying the thin, continuous gallbladder wall (thin arrows).

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Dysplasias;

    T2-weighted images (a-b, fat-suppressed c) confirmed intraluminal gallbladder mass (arrowheads) with low signal intensity, overlying the thin, continuous gallbladder wall (thin arrows).

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Dysplasias;

    T2-weighted images (a-b, fat-suppressed c) confirmed intraluminal gallbladder mass (arrowheads) with low signal intensity, overlying the thin, continuous gallbladder wall (thin arrows).

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Dysplasias;

    The intraluminal gallbladder mass (arrowheads) did not show diffusion restriction at b 800 (d) with corresponding apparent diffusion coefficient (ADC) value 2.1x10-3 mm2/s (e).

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Dysplasias;

    The intraluminal gallbladder mass (arrowheads) did not show diffusion restriction at b 800 (d) with corresponding apparent diffusion coefficient (ADC) value 2.1x10-3 mm2/s (e).

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Dysplasias;

    MR-cholangiopancreatography images showed small filling defects (arrows) in the non-dilated common bile duct, consistent with sludge, blood clots or fragments of the gallbladder mass (arrowheads).

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: MR; Procedure: Cholangiography; Special Focus: Neoplasia;
     
     
  • Figure 4
    MRI - Precontrast and dynamic enhanced T1-weighted images
     

    The intraluminal gallbladder mass (arrowhead) showed low-to-intermediate precontrast T1 signal intensity.

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Dysplasias;

    The intraluminal gallbladder mass was moderately and homogeneously enhanced in the arterial phase (b, c with subtraction) after intravenous gadolinium contrast (gadobutrol).

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Dysplasias;

    The intraluminal gallbladder mass was moderately and homogeneously enhanced in the arterial phase (b, c with subtraction) after intravenous gadolinium contrast (gadobutrol).

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Dysplasias;

    Portal venous (d,e) and equilibrium phase (f) showed persistent moderate and homogeneous enhancement of the gallbladder mass (arrowheads); normally enhancing, thin and continuous gallbaldder wall (thin arrows).

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Dysplasias;

    Portal venous (d,e) showed persistent moderate and homogeneous enhancement of the gallbladder mass (arrowheads); normally enhancing, thin and continuous gallbaldder wall (thin arrows), nonenhanced duodenal lipoma...

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Dysplasias;

    Portal venous (d,e) and equilibrium phase (f) showed persistent moderate and homogeneous enhancement of the gallbladder mass (arrowheads); normally enhancing, thin and continuous gallbaldder wall (thin arrows).

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Dysplasias;
     
     
Sonography showed a large (maximum diameter 3.6 cm) non-mobile homogeneous intraluminal mass (arrowheads), approximately isoechoic with the liver, overlying the continuous, non-thickened gallbladder wall (thin arrows).
 
The gallbladder intraluminal mass (arrowheads) was seen overlying the continuous, non-thickened gallbladder wall (thin arrows), showed lobulated margins and appeared approximately isoechoic with the liver.
 
The intraluminal gallbladder mass (arrowhead) overlying the non-thickened wall (thin arrow) showed solid attenuation values (28-30 Hounsfield units) on unenhanced scans. Note fatty liver, peripancreatic oedema (*).
 
Post-contrast images showed moderately vascularised gallbladder intraluminal mass (arrowheads) with vascular pedicle in the arterial-dominant (b,c) phase. Note continuous, normally enhancing gallbladder wall (thin arrows), peripancreatic oedema (*).
 
Moderately vascularised intraluminal mass (arrowheads) with vascular pedicle in the arterial-dominant (b,c) phase. Note normal thickness and enhancement of gallbladder wall (thin arrows), duodenal lipoma (thick arrow)
 
Portal venous phase images (d,e) showed moderately enhancing intraluminal gallbladder mass (arrowheads) overlying the normal gallbladder wall (thin arrows). Note normal pancreatic enhancement, peripancreatic oedema (*).
 
Portal venous phase images (d,e) showed moderately enhancing intraluminal gallbladder mass (arrowheads) overlying the normal gallbladder wall (thin arrows). Note normal pancreatic enhancement, duodenal lipoma (thick arrow).
 
T2-weighted images (a-b, fat-suppressed c) confirmed intraluminal gallbladder mass (arrowheads) with low signal intensity, overlying the thin, continuous gallbladder wall (thin arrows).
 
T2-weighted images (a-b, fat-suppressed c) confirmed intraluminal gallbladder mass (arrowheads) with low signal intensity, overlying the thin, continuous gallbladder wall (thin arrows).
 
T2-weighted images (a-b, fat-suppressed c) confirmed intraluminal gallbladder mass (arrowheads) with low signal intensity, overlying the thin, continuous gallbladder wall (thin arrows).
 
The intraluminal gallbladder mass (arrowheads) did not show diffusion restriction at b 800 (d) with corresponding apparent diffusion coefficient (ADC) value 2.1x10-3 mm2/s (e).
 
The intraluminal gallbladder mass (arrowheads) did not show diffusion restriction at b 800 (d) with corresponding apparent diffusion coefficient (ADC) value 2.1x10-3 mm2/s (e).
 
MR-cholangiopancreatography images showed small filling defects (arrows) in the non-dilated common bile duct, consistent with sludge, blood clots or fragments of the gallbladder mass (arrowheads).
 
The intraluminal gallbladder mass (arrowhead) showed low-to-intermediate precontrast T1 signal intensity.
 
The intraluminal gallbladder mass was moderately and homogeneously enhanced in the arterial phase (b, c with subtraction) after intravenous gadolinium contrast (gadobutrol).
 
The intraluminal gallbladder mass was moderately and homogeneously enhanced in the arterial phase (b, c with subtraction) after intravenous gadolinium contrast (gadobutrol).
 
Portal venous (d,e) and equilibrium phase (f) showed persistent moderate and homogeneous enhancement of the gallbladder mass (arrowheads); normally enhancing, thin and continuous gallbaldder wall (thin arrows).
 
Portal venous (d,e) showed persistent moderate and homogeneous enhancement of the gallbladder mass (arrowheads); normally enhancing, thin and continuous gallbaldder wall (thin arrows), nonenhanced duodenal lipoma (thick arrow).
 
Portal venous (d,e) and equilibrium phase (f) showed persistent moderate and homogeneous enhancement of the gallbladder mass (arrowheads); normally enhancing, thin and continuous gallbaldder wall (thin arrows).
 
 
 
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