0:01

So this patient is a 7-year-old female, uh,

0:03

history provided is biliary ductal dilatation.

0:05

TThey saw another imaging modality,

0:07

they wanted to get an MR to investigate

0:09

the etiology of the ductal dilatation.

0:13

So I'm going to start off by looking at the axial T2

0:16

non-fat saturated image to get a lay of the land.

0:19

And again, I'm going to focus on the

0:20

gallbladder over here and let me just

0:22

scroll through the images one time.

0:24

I often just scroll through at one time

0:25

just to get a big picture evaluation and

0:28

then go through evaluating specific things.

0:30

And so, sort of looking at this immediately,

0:33

the gallbladder again doesn't look very happy.

0:36

Look at the wall.

0:37

It's not very, it's not contiguous.

0:39

There are areas that are discontinuous

0:41

and associated with them, you have these

0:43

little collections, these T2 hyperintense

0:45

collections, one here, one here, and quite a

0:47

larger one over here, actually, that's forming.

0:50

Um, and you can see that it's sort of, this is

0:53

the sort of the neck of that collection that's

0:54

in contiguity with the gallbladder itself.

0:58

These findings can also be

1:00

appreciated on the coronal image.

1:02

Overall, this gallbladder is a little bit distended.

1:04

You can see that this is the gallbladder.

1:06

This is the sort of collection that's

1:07

adjacent to it that's communicating with it.

1:10

And you can see another collection over here.

1:13

And overall, the wall of it

1:14

just looks very, very irregular.

1:18

On the post-contrast image, let's have a look at this.

1:20

This is a T1 fat-saturated post-contrast

1:25

in the portal venous phase.

1:27

You can see the mucosa of the gallbladder is

1:29

enhancing in some areas pretty homogeneously,

1:32

but then it's missing in other areas.

1:34

And in the areas that it's missing, you have

1:36

these outpouchings associated with these focal

1:39

collections, one over there, perhaps a smaller one

1:41

over there, and, uh, quite a large one over here,

1:45

a discrete collection with a rim around it, uh,

1:48

that's associated with this, with this gallbladder.

1:53

One of the other things I wanted to show you here

1:55

is, uh, the subtle hyperemia that's

1:58

associated, we talked about the liver

2:00

hyperemia adjacent to the gallbladder.

2:02

Again, it's a subtle finding, but it is definitely

2:04

there, right where the liver is, at that interface

2:07

with the gallbladder, the parenchyma is more hyper

2:09

intense, and that's best seen on the arterial phase.

2:11

Again, it just tells us that, uh, the

2:14

gallbladder adjacent to it is likely inflamed.

2:19

And so putting this together, this is another

2:20

case of complicated cholecystitis, in which,

2:24

you know, wall gangrene has developed, there is

2:26

perforation, and associated with the perforations,

2:28

you have these abscesses that have developed.

2:31

Um, this is not just sort of fluid that's leaking

2:34

out, it's fluid that was leaking out that,

2:37

that now has a relatively discrete rim around it.

2:41

That the body has sort of walled off,

2:43

um, and now constitutes an abscess.

2:45

So again, something like this probably requires

2:48

a percutaneous cholecystostomy drainage.

2:51

Sometimes these abscesses can sort

2:53

of extend into the liver itself.

2:54

And so those would require drainage.

2:57

And so after those interventions

2:59

are done, patients will then typically go

3:02

ahead and get a cholecystectomy when it's

3:05

clinically appropriate for the patient to do so.