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Case Reports
. 2013 Aug 17;7(2):347-51.
doi: 10.1159/000354789. eCollection 2013.

A phrygian cap

Marie-Janne S van Kamp  1 , Donald E Bouman, Pascal Steenvoorde, Joost M Klaase
Affiliations
Case Reports

A phrygian cap

Marie-Janne S van Kamp et al. Case Rep Gastroenterol. .

Abstract

A Phrygian cap is a congenital anomaly of the gallbladder with an incidence of 4%. It can simulate a mass in the liver during hepatobiliary imaging and is sometimes mistaken for pathology. A Phrygian cap, however, has no pathological significance and normally causes no symptoms. A case will be presented where a Phrygian cap was found by coincidence during surgery. The patient was operated for colon cancer with liver metastasis in segment V. He underwent a simultaneous right hemicolectomy and wedge resection of the liver lesion. During perioperative inspection, a gallbladder with a folded fundus was seen. This deformity was, in retrospective, detected on the preoperative MRI scan. The patient underwent cholecystectomy to make the wedge resection easier to perform. Otherwise, cholecystectomy for a Phrygian cap is only indicated in case of symptoms. Radiographic imaging can be helpful in narrowing the differential diagnosis. To our knowledge, there is no recent literature about the Phrygian cap and its imaging aspects. Nowadays, multiphase MRI, or multiphase CT in case of MRI contraindication, are the first choices of hepatobiliary imaging.

Keywords: Cholecystectomy; Congenital anomaly; Gallbladder abnormalities; Gallbladder imaging.

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Figures

Fig. 1
Fig. 1
Perioperative photograph of the gallbladder. The fundus of the gallbladder is folded like a cap (arrow).
Fig. 2
Fig. 2
T2-weighted preoperative MRI of the liver showing a hypo-intensity on the ventral side of the gallbladder (arrow). This hypo-intensity is caused by the Phrygian cap and was seen on the MRI in retrospect.
Fig. 3
Fig. 3
This statue wears a conical headdress which fits closely around the head and is characterized by the top pulled forward. This cap is associated in antiquity with the inhabitants of former Phrygia.
See this image and copyright information in PMC

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