Interactive Transcript
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So this patient is a 7-year-old female, uh,
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history provided is biliary ductal dilatation.
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TThey saw another imaging modality,
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they wanted to get an MR to investigate
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the etiology of the ductal dilatation.
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So I'm going to start off by looking at the axial T2
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non-fat saturated image to get a lay of the land.
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And again, I'm going to focus on the
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gallbladder over here and let me just
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scroll through the images one time.
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I often just scroll through at one time
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just to get a big picture evaluation and
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then go through evaluating specific things.
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And so, sort of looking at this immediately,
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the gallbladder again doesn't look very happy.
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Look at the wall.
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It's not very, it's not contiguous.
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There are areas that are discontinuous
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and associated with them, you have these
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little collections, these T2 hyperintense
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collections, one here, one here, and quite a
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larger one over here, actually, that's forming.
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Um, and you can see that it's sort of, this is
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the sort of the neck of that collection that's
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in contiguity with the gallbladder itself.
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These findings can also be
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appreciated on the coronal image.
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Overall, this gallbladder is a little bit distended.
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You can see that this is the gallbladder.
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This is the sort of collection that's
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adjacent to it that's communicating with it.
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And you can see another collection over here.
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And overall, the wall of it
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just looks very, very irregular.
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On the post-contrast image, let's have a look at this.
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This is a T1 fat-saturated post-contrast
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in the portal venous phase.
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You can see the mucosa of the gallbladder is
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enhancing in some areas pretty homogeneously,
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but then it's missing in other areas.
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And in the areas that it's missing, you have
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these outpouchings associated with these focal
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collections, one over there, perhaps a smaller one
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over there, and, uh, quite a large one over here,
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a discrete collection with a rim around it, uh,
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that's associated with this, with this gallbladder.
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One of the other things I wanted to show you here
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is, uh, the subtle hyperemia that's
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associated, we talked about the liver
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hyperemia adjacent to the gallbladder.
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Again, it's a subtle finding, but it is definitely
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there, right where the liver is, at that interface
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with the gallbladder, the parenchyma is more hyper
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intense, and that's best seen on the arterial phase.
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Again, it just tells us that, uh, the
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gallbladder adjacent to it is likely inflamed.
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And so putting this together, this is another
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case of complicated cholecystitis, in which,
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you know, wall gangrene has developed, there is
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perforation, and associated with the perforations,
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you have these abscesses that have developed.
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Um, this is not just sort of fluid that's leaking
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out, it's fluid that was leaking out that,
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that now has a relatively discrete rim around it.
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That the body has sort of walled off,
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um, and now constitutes an abscess.
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So again, something like this probably requires
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a percutaneous cholecystostomy drainage.
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Sometimes these abscesses can sort
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of extend into the liver itself.
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And so those would require drainage.
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And so after those interventions
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are done, patients will then typically go
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ahead and get a cholecystectomy when it's
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clinically appropriate for the patient to do so.
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