PP-01 Phrygian cap of gallbladder a case report

Objective

The gallbladder is an organ that resembles a pear in shape and serves to store bile. Numerous anomalies and variations have been described regarding the location, shape, number and size of the gallbladder. Starting from the 4th week of pregnancy, the liver, gallbladder and bile ducts emerge as ventral buds from the most caudal part of the foregut.[1] In the embryological period, the folding of the fundus of the gallbladder causes the appearance of an image called the Phrygian cap on ultrasound. Phrygian cap is the most common congenital anomaly of the gallbladder and can be confused with a liver mass or gallbladder duplication ultrasonographically. The frequency of the Phrygian cap has been reported as 1-6%.[2-4] The Phrygian cap is not pathologically significant, but it is important to distinguish it from other possible diagnoses ultrasonographically in the antenatal period.[5] We aimed to share our case diagnosed with ultrasonography in the antenatal period, accompanied by bilateral pelviectasis, and the management of the case.
 

Methods

Computer-based and ultrasonography records of the case with Phrygian cap and pelviectasis, who applied to the Perinatology outpatient clinic of Prof. Dr. Cemil Taşçıoğlu City Hospital at the 20th week of pregnancy, were scanned retrospectively from the hospital system and the history of the ultrasonography device. Fetal ultrasonography examination and abdominal ultrasonography during the neonatal period were performed using Mindray Resona 7 device and its 1.2-6 MHz convex abdominal probe. Ultrasonography findings and patient history were noted.
Case: 26-year-old primagravid patient applied to our polyclinic for detailed ultrasonography at the 20th week of her pregnancy. There was no additional feature in her anamnesis and it was learned that the first trimester screening test was reported as low risk. On ultrasonography, the gallbladder had the appearance of Phrygian cap (Figure 1,2), and right renal anteroposterior (AP) diameter: 9 mm, left renal AP diameter: 7.7 mm, it was evaluated as bilateral pelviectasis, no additional anomaly was observed. In the control examination performed at 32 weeks, right renal AP diameter: 6.3 mm, left renal AP diameter: 5.5 mm. The pregnant woman, who had no features in her follow-ups, was delivered by cesarean section at 39 weeks with an indication of breech presentation. In the postnatal period, the gallbladder was reported as Phrygian cap in the abdominal ultrasonography performed on the newborn, the anteroposterior diameter of the pelvis in the bilateral kidneys was evaluated as normal, and no problems were observed in the newborn follow-ups.

Results

Phrygian cap is the most common congenital anomaly of the gallbladder. Although this image, which is formed by the folding of the gallbladder from the fundus, is not clinically meaningful, pathologies with clinical significance such as tumoral mass in the liver or gallbladder and duplication are included in the differential diagnosis. For these reasons, making the diagnosis carefully, informing the family about other possible diagnoses, and confirming the diagnosis with abdominal ultrasonography or MRI in the postnatal period are vital for the clinical course.

Keywords

Gallbladder, pyrgian cap, ultrasound

1. Severn CB. A morphological study of the development of the human liver. I. Development of the hepatic diverticulum. American Journal of Anatomy. 1971 Jun;131(2):133–58. 
2. Kokilavani J, Indiran V. Phrygian cap. Abdominal Radiology. 2017 Jul 15;43(5):1264–5. 
3. Edell S: A comparison of the Phrygian cap deformity with bistable and gray scale ultrasound. J Clin Ultrasound 1978;6:34–35. 
4. Meilstrup JW, Hopper KD, Thieme GA. Imaging of gallbladder variants. American Journal of Roentgenology. 1991 Dec;157(6):1205–8. 
5. Kamp MJS van, Bouman DE, Steenvoorde P, Klaase JM. A Phrygian Cap. Case Reports in Gastroenterology. 2013;7(2):347–51. 

	File/Dsecription
	Fig.1 Ultrasonographic view of the Phrygian cap gallbladder
	Fig.2 Phrygian cap gallbladder