Presentation
Right upper quadrant pain, Murphy's positive
Patient Data
The liver parenchyma is homogeneous in echotexture, and its surface has a smooth contour. The contour of the parenchyma abutting the hepatic veins is reasonably smooth. Multiple echogenic liver lesions likely represent hemangioma.
Doppler scanning demonstrated normal direction of flow in the main portal vein. No porto systemic varices detected.
Two gallbladders are present. Both appear to have thick walls however are collapsed limiting assessment. No gallstones identified. The common bile duct measures 2 mm in maximal caliber.
No intrahepatic or extrahepatic duct dilatation was detected. Sonographic Murphey's positive.
The head and neck of the pancreas appear normal. The tail is poorly imaged due to overlying gas.
Conclusion
Duplicated gallbladder. Sonographic Murphey's positive. While the gallbladders appear thick walled, assessment is limited as they are largely collapsed. Splenomegaly.
Duplex gallbladder. Each of the gallbladder lumens have a draining cystic duct which converge with the common hepatic duct in a single anastomosis to form the common bile duct. Single filling defect measuring 3 mm noted within the most medial gallbladder lumen.
Impression:
Duplex gallbladder and cystic ducts. The cystic ducts and the common hepatic duct have a single anastomosis forming the common bile duct.
Case Discussion
There are no specific symptoms attributed to gallbladder duplication and clinical symptoms are similar to that of a single gallbladder. Identification of duplication is important for operative planning prior to cholcystectomy.