biliary pancreatitis Dr Jesus Perdomo Foundation Year 1 Dr Brian Morrissey Final Year Radiology Trainee Dr Rosalind MitchellHay Consultant Radiologist Mr Mudassar Ghazanfar Consultant General ID: 1035767
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1. A case of falciform ligament pseudocyst in the context of acute biliary pancreatitisDr Jesus Perdomo (Foundation Year 1), Dr Brian Morrissey (Final Year Radiology Trainee), Dr Rosalind Mitchell-Hay (Consultant Radiologist), Mr Mudassar Ghazanfar (Consultant General Surgeon)Aberdeen Royal Infirmary, NHS Grampian
2. Case Synopsis70 year old gentleman admitted in late June for a laparoscopic cholecystectomyPresented 2 months prior with vague abdominal pain, raised inflammatory markers, and deranged liver function tests with an obstructive-type picture. Initial CT showed minor pericholestatic fat stranding, and subsequent MRCP appearances were compatible with acute calculus cholecystitisOn this second admission, he was re-scanned due to ongoing pain and abnormal blood results, including an elevated amylaseMRCP #2 – Distended gallbladder with calculi. Note is made of an incidental heterogeneous, well-defined, fluid-filled tubular structure along the anatomical position of the falciform ligament and ligamentum teres, separate from the colon and adjacent small bowel. The appearances had changed since the previous MRCP and CT scans in April. CT #2 – Given MRCP findings, the patient had a second CT scan for characterisation of this abnormality. The fluid-filled/cystic appearing tubular structure noted on MRCP is again demonstrated, measuring approximately 27 (AP) x 29 (TR) x 110 (CC) mm, and extending from the falciform ligament along the course of the remnant umbilical vein/ligamentum teres. Cranially, there was more heterogeneously dense tissue component, with fluid/cystic component caudally. When viewed in sagittal plane, there appears to be continuation of the umbilical vein inferiorly.The patient underwent a laparoscopic cholecystectomyThe surgical findings correlated with the radiological reports. A large cystic-looking tubular structure was successfully removed during laparoscopy. Histopathology revealed appearances in keeping with a pseudocyst, with a tube-like portion lined by xanthogranulomatous inflammation and filled with necrotic-like debris with cystic degeneration.
3. Initial CT showing acute cholecystitis and a normal-looking umbilical vein remnantCoronal MR view of second-admission MRCP showing new tubular abnormality originating from the anatomical position of the falciform ligament Axial MR view of tube-like abnormality (arrow) along multiple small calculi within the gallbladderSagittal view of CT obtained during second admission showing cholecystitis and the fluid-filled/cystic appearing tubular structure extending from the falciform ligament along the course of the remnant umbilical vein/ligamentum teres measuring 27 (AP) x 29 (TR) x 110 (CC) mm