The US and MRI demonstrate multiple large polyps without evidence of invasion.

 MRCP demonstrates multiple intrahepatic and extrahepatic biliary strictures consistent with multifocal cholangiopathy. In a patient with UC, this is in keeping with primary sclerosing cholangitis (PSC).

The management and follow-up of gallbladder polyps is controversial and practice varies between centers. However, due to the increased risk of malignancy, two clear indications for surgical referral for consideration of cholecystectomy are: 

• size is 10mm or greater
• high-risk patients (including patients with PSC) with polyps 5mm or greater ¹

This patient went on to have a cholecystectomy which demonstrated T1a N0 cancer within the gallbladder polyps. 

Case courtesy of Dr Jamie Franklin and Dr Ed Godfrey on behalf of the British Society of Gastrointestinal and Abdominal Radiology.