0:01

This next patient is a seven-year-old male who

0:03

presents with right upper quadrant pain.

0:05

Um, got some other imaging, but then the

0:07

referring providers wanted to get an MRI.

0:09

They wanted to get it with and

0:10

without intravenous contrast.

0:12

They wanted an MRCP sequence.

0:13

So we were happy to oblige and try to help them out.

0:16

And so we'll start off as I start off

0:18

most MRIs of the abdomen, really, uh,

0:20

whether it's the gallbladder or not.

0:21

T2, uh, non-fat-saturated image.

0:24

And, uh, you know, there's a lot of stuff going on,

0:26

but we're going to just focus on the gallbladder

0:27

over here, which is seen again in the right upper

0:29

quadrant, nice T2 hyperintense signal within it.

0:33

And as you see it, you notice that the

0:35

shape of it is not exactly the same

0:37

completely oval or pear-shaped as what you

0:40

would expect a normal gallbladder to look like.

0:42

Certainly, portions of it look that way,

0:45

but as you get towards the fundus of the

0:47

gallbladder, it has a different appearance.

0:49

It almost looks like it's

0:51

folded up on itself over there.

0:53

Let's see what that looks like on the

0:54

coronal T2-weighted non-fat-saturated image.

0:58

You can see beautifully the gallbladder over here,

1:00

and, uh, the cystic duct sort of appearing here, but

1:03

we're going to focus on the fundus of the gallbladder.

1:05

And again, as we get to the fundus of the

1:07

gallbladder, it almost looks like, well,

1:09

there's just an anatomic abnormality over there.

1:11

It doesn't look quite, uh, oval over there.

1:14

And, uh, you know, that imaging appearance is

1:16

persistent amongst, uh, different sequences.

1:18

This is our T2-weighted fat-saturated image.

1:21

We can again see the gallbladder has a relatively

1:23

hyperintense signal and has that sort of,

1:26

uh, appearance of the gallbladder fundus.

1:28

And so the reason I wanted to show this

1:30

case was to show you a very common

1:34

anatomic variant of the gallbladder.

1:35

So if you've not really seen this before,

1:37

there's no reason to get worried about it.

1:39

This is known as the Phrygian cap, and it's reportedly

1:42

seen in up to 6 percent of patients on, uh, you know,

1:46

when evaluating the gallbladder, and it's just

1:49

simply a folding of the gallbladder fundus upon itself.

1:52

And so, you know, a lot of times it's important

1:54

to know anatomic variants so that you don't

1:57

mistake it for something that is more worrisome.

1:59

And so this is one of those things that's just,

2:03

one of the other reasons I wanted to show this

2:04

case is, uh, one of the things we talked about

2:07

in the, uh, normal appearance of the gallbladder

2:09

was this idea that if you have concentrated

2:12

bile, it appears slightly more hypointense on T2

2:15

weighted images and can have that layering effect.

2:18

And so if you see over here, uh, probably

2:20

because of the gallbladder folding, there's

2:22

an area of relative stasis of the bile.

2:24

You can see it's bright, hyper

2:26

intense, T2 hyperintense bile up here.

2:28

And below, a little bit more concentrated

2:30

with a very discreet, uh, level over there.

2:33

So that's just a little bit of concentrated bile that's

2:35

hanging out, uh, in the fundus of the gallbladder.

2:38

So once again, this is just a normal variant

2:40

of Phrygian cap, seen in up to 6 percent of patients

2:42

folding the gallbladder fundus upon itself.