case_images: PMC6601483_01
case_images: Preoperative thin slice MRCP images in axial (a), coronal (b), and sagittal planes (c). A normal cystic duct (CD) is seen at the GB neck medially (short arrows in (a), (b)). Arising from the posterior wall of the infundibulum is an accessory duct (long arrows in (a), (b)). Sagittal image demonstrates layering sludge within the dependent portions of the GB body and infundibulum as well as a hypointense gallstone (arrow in (c)).
case_images: CRIRA2019-6812793.001.jpg
case_images: PMC6601483_01_CRIRA2019-6812793.001.jpg
case_images: fig1
case_images: It was also noted on MRCP that an accessory bile duct was present arising from the right hepatic ductal system and inserting into the infundibulum of the GB (Figure 1).
case_images: (a) Frontal fluoroscopic scout image of the PCT. (b, c) Digital subtraction cholecystography (cholecystogram). (b) Filling of the gallbladder via contrast injection through the PCT demonstrates early filling of the gallbladder as well as the common bile duct (CBD) and CHD via the CD (arrowhead). An additional duct is seen extending superiorly from the gallbladder (arrow). (c) The accessory duct eventually communicates with the right posterior duct (RPD) (long arrow). Contrast also refluxes into a smaller segmental duct extending from segment VII (short arrow) and feeds into the accessory cholecystohepatic duct.
case_images: CRIRA2019-6812793.002.jpg
case_images: PMC6601483_01_CRIRA2019-6812793.002.jpg
case_images: fig2
case_images: During the PCT placement cholecystogram, the accessory bile duct was seen extending from the GB and connecting to the right posterior duct (RPD) (Figure 2).
case_images: Postoperative thin slice MRCP images in sagittal (a) and axial (b) planes. Fluid collection with layering debris is present in the gallbladder fossa. (a) The cholecystohepatic duct terminates within the collection, entering posteriorly (arrow). (b) More superiorly, the duct is again seen posterior to the fluid collection (arrow). It is in a similar location compared to the preoperative imaging, but slightly more dilated. The common hepatic duct is also seen more medially (arrowhead).
case_images: CRIRA2019-6812793.003.jpg
case_images: PMC6601483_01_CRIRA2019-6812793.003.jpg
case_images: fig3
case_images: Subsequent MRCP (Figure 3) depicts the cholecystohepatic duct terminating in the fluid collection within the gallbladder fossa.