Type IV variant biliary anatomy with cholelithiasis, cholecystitis and dilated right sided biliary radicals.
Diagnosis almost certain
Presentation
Right hypochondrium pain
Patient Data
Age: 40 years
Gender: Male
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- type IV biliary variant anatomy is seen with right hepatic duct draining into the cystic duct.
- calculus measuring 14 mm in gallbladder lumen
- calculus measuring 12 mm in the neck of gallbladder / cystic duct, extending into right hepatic duct
- right hepatic duct is dilated, measuring 7 mm
- distal right sided biliary radicals are mildly prominent
- gallbladder walls are thickened and irregular, measuring up to 7 mm in thickness
- pericholecystic edema is seen
Case Discussion
There are a lot of anatomical variants in the biliary tree. Identifying them is important, such as in this case, where the right hepatic duct dilatation is due to its drainage into cystic duct.
Apart from cholelithiasis and cholecystitis, the above finding will guide the surgeon's approach to the case.
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