Figure 1
Coronal T2-weighted MRI
A pear-shaped focal cystic lesion is seen within the hepatic parenchyma along its antero-inferior aspect.
Intrahepatic gall bladder
SectionAbdominal imaging
Case TypeAnatomy and Functional Imaging
AuthorsArora A, Bhutani R, Gupta R, Mahajan H
Connected authors
30 years, male
Clinical History
A 30-year-old male patient was evaluated for chronic indigestion.
Imaging Findings
Transabdominal sonogram revealed an abnormal position of the gall bladder. Subsequent axial and coronal MR images demonstrated a pear-shaped focal cystic lesion within the hepatic parenchyma along its antero-inferior aspect, consistent with an intrahepatic location of the gallbladder. On MRCP images, the cystic duct showed an aberrant high insertion into the common duct near the primary biliary confluence.
Discussion
Ectopic gallbladder is a rare congenital anomaly with an incidence of approximately 0.1 – 0.7 per cent in the general population. Ectopic gallbladder has been classified into four types: intrahepatic, transverse, retroplaced and left sided, i.e. to the left of the falciform ligament. Rarely, ectopic gall bladder has been reported in the lesser omentum, falciform ligament, the retroduodenal area, within the abdominal wall muscles, and within the thorax. Intrahepatic gall bladder is usually located in the subcapsular location along the antero-inferior aspect of the right lobe of liver. Normally the gall bladder develops from a diverticulum arising from the ventral foregut. This diverticulum further divides into cranial and caudal parts, amongst which the caudal portion forms the gall bladder and the extrahepatic bile ducts. An ectopic gall bladder is believed to be due to an abnormal development or a congenital arrest which prevents the gallbladder from moving from its intrahepatic position into its normal superficial location between the left and right lobes. An ectopic gall bladder can create clinical confusion and misreading of imaging findings. Awareness of the possibility of such anatomic variants can aid in arriving at a correct diagnosis on US, CT and MR imaging. As an intrahepatic gallbladder is partially or completely embedded within the hepatic parenchyma, it usually has an impaired function which may result in gallstone formation owing to incomplete emptying and stasis.
Differential Diagnosis List
Intrahepatic gall bladder
Final Diagnosis
Intrahepatic gall bladder
References
[1] Meilstrup JW, Hopper KD, Thieme GA (1991) Imaging of gallbladder variants. AJR Am J Roentgenol 157:1205-8 (PMID: 1950867)
[2] Lusink C, Sali A (1985) Intrahepatic gallbladder and obstructive jaundice. Med J Aust 142:53-4 (PMID: 3965877)
[3] Helmberger H, Hellerhoff K, Rüll T, Sorger N, Rösch T (2001) [Radiologic diagnosis of the gallbladder and bile ducts. 1: Imaging methods, normal anatomy and anatomic variants]. Radiologe 41:711-21; quiz 722-3 (PMID: 11552387)
Case information
| URL: | https://www.eurorad.org/case/8825 |
| DOI: | 10.1594/EURORAD/CASE.8825 |
| ISSN: | 1563-4086 |
Figure 2
Axial T2-weighted MRI
Axial MRI confirms the intrahepatic position of gall bladder.
Figure 3
MRCP
The gall bladder shows an ectopic location, the fundus facing cranially.
Figure 4
MRCP
The cystic duct showed an aberrant high insertion into the common duct near the primary biliary confluence (arrow).
Figure 5
MRCP
Coronal T2-weighted MRI
A pear-shaped focal cystic lesion is seen within the hepatic parenchyma along its antero-inferior aspect.
Axial T2-weighted MRI
Axial MRI confirms the intrahepatic position of gall bladder.
MRCP
The gall bladder shows an ectopic location, the fundus facing cranially.
MRCP
The cystic duct showed an aberrant high insertion into the common duct near the primary biliary confluence (arrow).
MRCP
