Left-sided gallbladder: its clinical significance and imaging presentations.
OBJECTIVE
To assess the importance of preoperative diagnosis and presentation of left-sided gallbladder using ultrasound (US), CT and angiography.


METHODS
Retrospective review of 1482 patients who underwent enhanced CT scanning was performed. Left-sided gallbladder was diagnosed if a right-sided ligamentum teres was present. The image presentations on US, CT and angiography were also reviewed.


RESULTS
Left-sided gallbladder was diagnosed in nine patients. The associated abnormalities on CT imaging included portal vein anomalies, absence of umbilical portion of the portal vein in the left lobe of the liver, club-shaped portal vein in the right lobe of the liver, and difficulty in identifying segment IV. Angiography in six of nine patients demonstrated abnormal portal venous system (trifurcation type in four of six patients). The main hepatic arteries followed the portal veins in all six patients. The segment IV artery was identified in four of six patients using angiography, although segment IV was difficult to define on CT imaging. Hepatectomy was performed in three patients with concomitant liver tumor and the diagnosis of left-sided gallbladder was confirmed intraoperatively.


CONCLUSIONS
Left-sided gallbladder is an important clinical entity in hepatectomy due to its associated portal venous and biliary anomalies. It should be considered in US, CT and angiography images that demonstrate no definite segment IV, absence of umbilical portion of the portal vein in the left lobe, and club-shaped right anterior portal vein.
Hsu
Sheng-Lung
SL
Department of Diagnostic Radiology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan, 123 Ta-Pei Road, Niao-Sung, Kaohsiung, 833, Taiwan, China.
Chen
Tai-Yi
TY
Huang
Tung-Liang
TL
Sun
Cheuk-Kwan
CK
Concejero
Allan M
AM
Tsang
Leo Leung Chit
LL
Cheng
Yu-Fan
YF
D000015:Abnormalities, Multiple / Q000000981:diagnostic imaging / Q000473:pathology*; D000792:Angiography; D002765:Cholecystography; D005704:Gallbladder / Q000002:abnormalities* / Q000473:pathology; D006498:Hepatectomy; D006499:Hepatic Artery / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D008022:Ligaments / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000473:pathology; D011169:Portal Vein / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D011172:Portography; D011300:Preoperative Care / Q000379:methods*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography