Agenesis of the gallbladder with the presence of a small dysmorphic cyst: role of magnetic resonance cholangiopancreatography

Abstract

We report a case of agenesis of the gallbladder with the presence of a small dysmorphic cyst, along the bed of the gallbladder and cystic duct. The patient presented to us with a suspected diagnosis of atrophic and sclerotic gallbladder that was not seen on ultrasound examination, indicating the need for cholecystectomy. The patient's medical history report mentioned agenesis of the left kidney. The existence of a congenital abnormality led us to suspect the inability to visualize the gallbladder was probably due to a possible agenesis of the gallbladder. The patient was investigated with magnetic resonance cholangiopancreatography (MRCP), that confirmed the suspected diagnosis and avoided unnecessary surgery. The hypothesis of anomalous development or agenesis of the gallbladder should always be suspected when the gallbladder is not visible on ultrasound imaging, especially in patients with other congenital anomalies. We believe that in all these patients, MRCP must always be performed to help make decisions on the treatment protocol.

Keywords: Congenital abnormality; MRCP; gallbladder agenesis; gallbladder scleroatrophic; renal agenesis.

Figure 1

Axial fast imaging employing steady-state acquisition image, shows a small cystic lesion (white arrow) along the course of the bed of the gallbladder, in proximity to the bile duct (dashed arrow).

Figure 2

Volume rendering technique images: (a) Front view; (b) lateral view; and (c) rear view show a small dysmorphic cystic dilatation (white arrow), which shows extensive communication with the bile duct (dashed arrow). The common bile duct is dilated (arrowhead), assuming the function of bile storage.

Figure 3

Images of virtual endoscopy of the biliary tract. (a) Cranial endoscopic view, from the common hepatic duct into the common bile duct. We can appreciate the wide communication between the bile duct and cystic dilatation (red curved arrow). (b) Caudal view from the common bile duct into the common hepatic duct. Input cystic dilatation (curved arrow red). (c) View from the bottom of the cystic dilatation, into the common bile duct; you can well appreciate the openings, respectively, of the common hepatic duct (curved arrow yellow) and the common bile duct (arrow red curve).