0:01

This patient is a 60-year-old

0:03

female, and it's for restaging.

0:05

I've got an MRI, and I'll start off with

0:08

looking at some of the axial T2 images, and

0:11

it's a little bit jumpy, so I'm not going to

0:13

go through all of them, but I want to just

0:15

focus on the findings in the gallbladder.

0:18

So as we look at the gallbladder here,

0:20

10 00:00:21,805 --> 00:00:23,404 we can probably see a small stone.

0:23

It's quite under-distended, so it's very challenging

0:25

to evaluate a lot of these things, but we'll see

0:27

better on some of the other imaging sequences.

0:30

But over here in the gallbladder, there's

0:32

another finding that, you know, it looks abnormal.

0:35

Some of this stuff may be sludge, may be

0:36

stones; we don't know, but certainly there's

0:38

something going on inside the gallbladder.

0:41

We note that this patient is post left

0:43

nephrectomy, and that there's at least

0:45

a lesion in the right adrenal gland.

0:46

And if we were to look closely at some of the

0:48

other imaging sequences, there's actually going

0:49

to be quite widespread metastatic disease.

0:52

I'll proceed to looking at the axial T1

0:55

Fatsat precontrast image, and this shows

0:58

an abnormality within the gallbladder.

1:00

There's sort of this mass-like lesion over here,

1:02

which, for the most part, is T1 hyperintense

1:05

internally, has sort of T1 hypointense content.

1:10

So then I'm going to jump to the

1:12

post-contrast subtraction sequence.

1:17

Because of the hyperintense T1 content,

1:18

I want to just see the subtracted image

1:20

that removes some of that content.

1:23

As we scroll through it, we can see that

1:24

there is an adrenal metastasis; there's

1:26

actually multiple pancreas metastases.

1:29

If you look at the gallbladder itself, a lot of

1:32

that hyperintense T1 content is not enhancing,

1:34

but that nodule within it is enhancing.

1:37

And so if you look at this, uh, given all the

1:39

findings that we see, that the patient is post

1:41

nephrectomy, has multiple metastatic deposits

1:44

elsewhere, and has an enhancing mass in the gallbladder,

1:47

this is worrisome for a gallbladder metastasis.

1:51

Now, gallbladder metastases are very uncommon.

1:54

It's not something you're going to see every day, but

1:56

you do end up seeing it in certain types of primary

1:59

neoplasms, particularly melanoma and renal cell cancer.

2:04

You often see it in the setting of

2:05

more widespread metastatic disease.

2:07

So I'm just going to go backwards in time

2:10

to show you a different study on the

2:12

same patient who had multiple implants

2:15

elsewhere from his renal cell neoplasm.

2:19

And you can see that this indeed was the gallbladder

2:22

metastasis within the gallbladder itself, and a lot

2:26

of that has undergone hemorrhagic transformation.

2:28

There's a nidus within it that's still

2:30

enhancing, as you can see over here.

2:32

But this is an example of a rare entity of

2:35

a gallbladder metastasis, something you see

2:37

with widespread disease and particularly in

2:39

patients with melanoma or renal cell carcinoma.