A Phrygian Cap

Abstract

A Phrygian cap is a congenital anomaly of the gallbladder with an incidence of 4%. It can simulate a mass in the liver during hepatobiliary imaging and is sometimes mistaken for pathology. A Phrygian cap, however, has no pathological significance and normally causes no symptoms. A case will be presented where a Phrygian cap was found by coincidence during surgery. The patient was operated for colon cancer with liver metastasis in segment V. He underwent a simultaneous right hemicolectomy and wedge resection of the liver lesion. During perioperative inspection, a gallbladder with a folded fundus was seen. This deformity was, in retrospective, detected on the preoperative MRI scan. The patient underwent cholecystectomy to make the wedge resection easier to perform. Otherwise, cholecystectomy for a Phrygian cap is only indicated in case of symptoms. Radiographic imaging can be helpful in narrowing the differential diagnosis. To our knowledge, there is no recent literature about the Phrygian cap and its imaging aspects. Nowadays, multiphase MRI, or multiphase CT in case of MRI contraindication, are the first choices of hepatobiliary imaging.

Unsuspected Phrygian Cap Gallbladder in a 71 Year Old Man

“…3 Folding or bending of the fundus over the body gives origin to a deformity called Phrygian cap gallbladder, similar to a headgear used by liberated Greek slaves of an ancient Turkish region. [2][3][4][5] Phrygian cap gallbladder is a rare congenital anomaly whose incidence is probably underestimated. This condition is more often incidentally diagnosed during cholecystectomies or autopsies.…”

“…This condition is more often incidentally diagnosed during cholecystectomies or autopsies. 3,4 However, if associated with cholelithiasis or cholecystitis, the chances of clinical diagnosis increase. 2 The diagnosis of Phrygian cap gallbladder herein described was incidental in a routine check up.…”

“…[2][3][4] Nevertheless, these differential diagnoses were all ruled out by features of gross pathologic study. High-resolution ultrasonography has been commonly used to detect the anomaly, in addition to computed tomography, magnetic resonance, retrograde cholangiography, orcholescintigraphy.…”

“…[1][2][3][4] This abnormality was first described by Boyden in 1935, [2][3][4][5] and its estimated incidence is 4%. [2][3][4] This developmental defect appears as folded gallbladder and results from kinking between the body and the fundus or the infundibulum. These deformities predispose to cholelithiasis due to biliary stasis in the corpus and fundus of the gallbladder.…”

“…These deformities predispose to cholelithiasis due to biliary stasis in the corpus and fundus of the gallbladder. 1 Phrygian cap anomaly by itself does not suggest invasive intervention, [2][3][4] but the suspicion of associated gallbladder polypsmay indicate the needfor surgical management. [7][8][9] The malignant potential of 10 mm polyps is high, but the smallerones must also be monitored.…”