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 Table of Contents     
CASE REPORT
Year : 2011  |  Volume : 26  |  Issue : 2  |  Page : 120-122  

Anomalously placed suprahepatic gall-bladder: A case detected on F-18 FDG PET/CT


Departments of Nuclear Medicine and Radiology, Medanta - The Medicity Hospital, Sector-38, Gurgaon, India

Date of Web Publication25-Nov-2011

Correspondence Address:
Vishal Agarwal
Departments of Nuclear Medicine and Radiology, Medanta - The Medicity Hospital, Sector-38, Gurgaon-122 001
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-3919.90270

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   Abstract 

The purpose of this study was to appraise the imageologists of a possible mislocalization of tracer accumulation to anomalously placed gallbladder during positron emission tomography-computed tomography (PET/CT) examination. PET/CT is increasingly playing an important role in staging and restaging of the disease process in cancer patients. With the advent of fusion imaging, the tracer accumulation can be correctly localized to a structure or lesion on CT. We did a staging PET/CT scan of a patient with hepatocellular carcinoma for liver transplant evaluation. Fluorine-18 fluorodeoxyglucose (F-18 FDG) was used as a tracer and the scan was performed on SEIMENS Biograph-mCT PET/CT machine. We noted the tracer accumulation at the superior surface of liver, which was localized to the anomalously placed gallbladder in suprahepatic subdiaphragmatic location. The anomalously placed gallbladder can create localization confusion. Keeping the possibility of ectopically placed gallbladder in mind, the imageologist can better localize the tracer uptake.

Keywords: Mislocalization, PET/CT, suprahepatic gallbladder


How to cite this article:
Agarwal V, Pande S, Garg SK, Jangid DR. Anomalously placed suprahepatic gall-bladder: A case detected on F-18 FDG PET/CT. Indian J Nucl Med 2011;26:120-2

How to cite this URL:
Agarwal V, Pande S, Garg SK, Jangid DR. Anomalously placed suprahepatic gall-bladder: A case detected on F-18 FDG PET/CT. Indian J Nucl Med [serial online] 2011 [cited 2019 Dec 13];26:120-2. Available from: http://www.ijnm.in/text.asp?2011/26/2/120/90270


   Introduction Top


When the gallbladder is not visualized in its normal location, the possibility of its ectopic location should be considered. A case of incidentally detected anomalous position of gall bladder causing confounding problem in interpretation of PET-CT is described.


   Case Report Top


A 70-year-old man, with h/o chronic liver disease and suspected of hepatocellular carcinoma [serum alpha-fetoprotein (AFP) 5024 ng/ml] was subjected to fluorine-18 fluorodeoxyglucose positron emission tomography (F-18 FDG PET)/computed tomography (CT) imaging. A focal FDG avid soft tissue was noted in the suprahepatic subdiaphragmatic location. Rest of the liver revealed non-FDG avid lesions in segments III and VIII. On viewing the fused PET/CT images, the radiotracer accumulation was localized to the anomalously placed suprahepatic gallbladder. Magnetic resonance (MR) images of the same patient confirmed the presence of the suprahepatic gallbladder [Figure 1].
Figure 1: (a) Transaxial view of PET image showing suprahepatic subdiaphragmatic gallbladder with tracer uptake; (b) Coronal view of PET image; (c) Sagittal view of PET image; (d) Transaxial view of CT image; (e) Coronal view of CT image; (f) Sagittal view of CT image; (g) Transaxial view of post-contrast T1-weighted MRI image; (h) Coronal view of post-contrast T1-weighted MRI image; (i) Transaxial view of T2 fat saturated MRI image shows gallbladder as a bright structure

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   Discussion Top


Routine imaging of the gallbladder demonstrates a wide array of imaging variants, including anomalies in location, number, and configuration. An awareness of these normal variants would prevent misdiagnosis and aid in the assessment of differential diagnostic possibilities.

Normally, the gallbladder is situated adjacent to the inferior surface of the liver, in the plane of the interlobar fissure, with the gallbladder neck maintaining a constant relationship to porta hepatis. The gallbladder is generally found in the right upper quadrant, but may be seen in other parts of the abdomen. While anomalous positions are rare, the most common of these are (1) under the left hepatic lobe, (2) intrahepatic, (3) transverse, and (4) retroplaced (retrohepatic or retroperitoneal). The lesser common of these are (1) supradiaphragmatic and (2) suprahepatic. Gallbladder is intrahepatic during the embryonic period and becomes extrahepatic only later. An intrahepatic gallbladder [1] (usually a congenital anomaly) has a subcapsular location along the anterior inferior right lobe of the liver. This poses a problem for scintigraphy, as an intrahepatic gallbladder can cause a focal defect [2] (pseudo-space-occupying lesion); ultrasonography can be helpful in these cases. A left-sided gallbladder location is seen in situs inversus totalis. A gallbladder in the left upper quadrant without situs inversus is even rarer. The retroplaced gallbladder is rare and is either congenital or acquired. Gallbladder rotation and/or displacement can be caused by hepatic lobe abnormalities, viz. aplasia, hypoplasia and hypertrophy, or by abnormal mobility of the gallbladder itself.

The suprahepatic region is among the rarest sites, and very few reports have appeared in either the surgical or radiological literature. [3],[4],[5]

Of the very few reports on the suprahepatic gallbladder, one refers to a normally inserted organ that rotated 180° upward to an intrathoracic position after eventration of the diaphragm. In two other cases, an abnormally mobile gallbladder was found trapped between the chest wall and the upper border of the liver; this became symptomatic and caught the attention of the clinician and the imageologist. [5] Faintuch et al. reported three cases of suprahepatic gallbladder with hypoplasia of the right hepatic lobe and upward migration of the gallbladder. [6] Gansbeke reported a case of suprahepatic gallbladder which was associated with hepatomegaly due to macronodular cirrhosis complicating existing hepatitis. [7] Kabaroudis reported a case of floating gallbladder associated with hypoplasia of the right hepatic lobe, [8] whereas Maeda had reported a similar case associated with hypoplasia of left hepatic lobe. [9]


   Conclusion Top


PET-CT is found to be useful in diagnosing this rare anatomical variant of ectopically located gall bladder and predicting its functional implication.

 
   References Top

1.Flanery MG, Caster MP. Congenital abnormalities of gallbladder: 101 cases. Instr Abstr Surg 1956;103:439-57.  Back to cited text no. 1
    
2.Schulz RC, Shields JB, Fletcher JW, Donati RM. Liver scanning and the intrahepatic gallbladder: Case report. J Nucl Med 1975;16:1029-30.  Back to cited text no. 2
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3.Gross RE. Congenital anomalies of gallbladder: A report of 148 cases with report of a double gallbladder. Arch Surg 1936;32:131-62.   Back to cited text no. 3
    
4.Meilstrup JW, Hopper KD, Thieme GA. Imaging of gallbladder variants. AJR Am J Roentgenol 1991;157:1205-8.  Back to cited text no. 4
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5.Regen JF, Poindnxrait A. Suprahepatic position of the gallbladder. Arch Surg 1965;90:175-6.  Back to cited text no. 5
    
6.Faintuch J, Machado MC, Raia AA. Suprahepatic gallbladder with hypoplasia of the right lobe of the liver. Arch Surg 1980;115:658-9.   Back to cited text no. 6
[PUBMED]  [FULLTEXT]  
7.Van Gansbeke D, de Toeuf J, Cremer M, Engelholm L, Struyven J. Suprahepatic gallbladder: A rare congenital anomaly. Gastrointest Radiol 1984;9:341-3.  Back to cited text no. 7
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8.Kabaroudis A, Papaziogas B, Atmatzidis K, Argiriadou E, Paraskevas A, Galanis I, et al. Hypoplasia of the right hepatic lobe combined with a floating gallbladder. Acta Chir Belg 2003;103:425-7.  Back to cited text no. 8
[PUBMED]    
9.Maeda N, Horie Y, Shiota G, Suou T, AndachI H, Kawasaki H. Hypoplasia of the left hepatic lobe associated with floating gallbladder: A case report. Hepatogastroenterology 1998;45:1100-3.  Back to cited text no. 9
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    Abstract
   Introduction
   Case Report
   Discussion
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    References
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