Agenesis of the Gallbladder with the Presence of a Small Dysmorphic Cyst: Role of Magnetic Resonance Cholangiopancreatography

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

The Case for MDCT

Multidetector CT (MDCT) examination with multiphasic acquisition should be advocated as routine study in patient investigated for pancreatic adenocarcinoma. The application of a biphasic protocol gives the best results, using a pancreatic phase for tumor identification and arterial infiltration, and portal phase for the assement of venous infiltration and liver metastasis. Pancreatic adenocarcinoma is classically visualized as an ill-defined solid mass, not capsulated, isodense to the pancreatic parenchyma in pre-contrast scan and hypo-attenuating in the pancreatic-portal phases. Ancillary signs can be helpful in the diagnosis of small tumors (< 2 cm) and isoattenuating adenocarcinoma. Several benign and malignant condition can mimick adenocarcinoma, in this case magnetic resonance and endoscopic ultrasonography biopsy can be helpful in diagnosis. MDCT enables an accurate tumor staging and presents a positive predictive values for unresectability between 89% to 100%; it also allows a complete preoperative planning and presents high accuracy both in surgical complications and tumor recurrence detection

Diagnosis and management of hepatic focal nodular hyperplasia

Focal nodular hyperplasia (FNH) is the second most common benign tumor of the liver, after hemangioma. It is generally found incidentally and is most common in reproductive-aged women, but it also affects males and can be diagnosed at any age. Patients are rarely symptomatic, but FNH sometimes causes epigastric or right upper quadrant pain. The main clinical task is to differentiate it from other hypervascular hepatic lesions such as hepatic adenoma, hepatocellular carcinoma, or hypervascular metastases, but invasive diagnostic procedures can generally be avoided with the appropriate use of imaging techniques. Magnetic resonance (MR) imaging is more sensitive and specific than conventional ultrasonography (US) or computed tomography (CT), but Doppler US and contrast-enhanced US (CEUS) can greatly improve the accuracy in the diagnosis of FNH. Once a correct diagnosis has been made, in most cases there is no indication for surgery, and treatment includes conservative clinical follow-up in asymptomatic patients. \ua9 2007 Elsevier Masson. All rights reserved