Gallbladder volvulus diagnosed by MRCP and diffusion-weighted imaging in an elderly woman

Sep 29, 2026

Uploaded by James

Gallbladder (GB) volvulus is an uncommon cause of acute abdominal pain and is often mistaken for acute cholecystitis because presentations are nonspecific. The report describes an 84-year-old woman with acute right upper quadrant pain and normal inflammatory markers. Ultrasound and contrast-enhanced CT suggested acalculous cholecystitis, while MRCP with diffusion-weighted imaging confirmed a whirl sign involving the cystic duct and artery and showed diffusion restriction consistent with acute ischemia from torsion.

LanguageEnglish

CategoryHealthcare

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Case Report

Diagnostic challenge and imaging workup

Case presentation and laboratory findings

Imaging findings on US, CT, and MRCP with DWI

Radiology Ca s e Reports 21 (2026) 1127 – 1130 Available online [at](at www.sciencedirect.com)[ www.sciencedirect.com](at www.sciencedirect.com) journal [homepage:](homepage: www.elsevier.com/locate/radcr)[ www.elsevier.com/locate/radcr](homepage: www.elsevier.com/locate/radcr) | Case Report
Gallbladder volvulus diagnosed by MRCP and diffusion-weighted imaging in an elderly woman ✩
Isaac Azad, MDa,b,∗, Ivan Arsic, MDb, Iben Gad Lauridsen, MDc, Tobias Stadil, MDc
a Department of Radiology, Aalborg Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark b Department of Radiology, Viborg Hospital, Heibergs Allé 4, 8800 Viborg, Denmark c Department of General surgery, Viborg Hospital, Heibergs Alle 5A, 8800 Viborg, Denmark | | | | --- | --- | --- | | a r t i c l e i n f o | | a b s t r a c t | | Article history:
Received 22 July 2025 Revised 17 November 2025 Accepted 18 November 2025 | | Gallbladder (GB) volvulus is a rare cause of acute abdominal pain and is frequently misdiagnosed as acute cholecystitis due to its nonspecific presentation. We report an elderly woman in whom magnetic resonance cholangiopancreatography (MRCP) with diffusionweighted imaging (DWI) enabled a timely, accurate preoperative diagnosis. An 84-year-old woman presented with acute right upper quadrant pain; inflammatory markers were normal. Ultrasound (US) and contrast-enhanced computed tomography (CT) suggested acalculous cholecystitis; CT showed a “whirl sign” but no V-shaped distortion of the extrahepatic ducts. MRCP confirmed a “whirl sign”involving the cystic duct and artery, and DWI demonstrated diffusion restriction in the GB wall, consistent with acute ischemia secondary to torsion. Laparoscopic cholecystectomy confirmed a 360° torsion with ischemic changes. This case highlights the limitations of US and the variable sensitivity of CT for GB volvulus, especially in atypical presentations. MRCP with DWI provides complementary anatomic and functional information, supporting a confident preoperative diagnosis and prompt surgical intervention.
© 2025 The Authors. Published by Elsevier Inc. on behalf of University of Washington.
This is an open access article under the CC BY license
([http://creativecommons.org/licenses/by/4.0/](http://creativecommons.org/licenses/by/4.0/)) | | Keywords:
Gallbladder (GB) volvulus
MRCPDWI Whirl sign
Ischemic cholecystitis | | | tributes to a low rate of correct preoperative diagnosis, historically between 10% and 26%[1,2] . The diagnostic challenge is often compounded by atypical presentations. Notably, up to 45% of patients may present without elevated inflammatory markers, making it difficult to differentiate GB volvulus from other acute abdominal conditions [2] . Anatomic predispositions for GB volvulus include an elongated mesentery, which increases GB mobility, and age-related liver atrophy or loss of visceral fat, which can result in a “floating GB” [2] . ✩ Competing Interests: The authors have declared that no competing interests exist. ∗ Corresponding author. E-mail address: [I.azad@rn.dk](I.azad@rn.dk) (I. Azad). [https://doi.org/10.1016/j.radcr.2025.11.051](https://doi.org/10.1016/j.radcr.2025.11.051) 1930-0433/© 2025 The Authors. Published by Elsevier Inc. on behalf of University of Washington. This is an open access article under the CC BY license ([http://creativecommons.org/licenses/by/4.0/](http://creativecommons.org/licenses/by/4.0/)) Ultrasound (US) and computed tomography (CT) are the standard first-line imaging modalities, but their findings in GB volvulus, such as GB distension, wall thickening, and pericholecystic fluid, are often nonspecific. Magnetic resonance cholangiopancreatography (MRCP) provides superior sensitivity for biliary pathology, with recent studies reporting 95& - 100% sensitivity for gallstone detection [4] . When combined with diffusion-weighted imaging (DWI), which is highly sensitive for detecting acute ischemic changes [5], this adv

FAQs

Why is gallbladder volvulus commonly misdiagnosed as acute cholecystitis?

Its presentation is nonspecific and overlaps with acute cholecystitis, leading to low historically correct preoperative diagnosis rates and diagnostic difficulty, especially when inflammatory markers are not elevated.

What did CT show in this case and what was the limitation?

CT demonstrated a “whirl sign” suggesting torsion, but it did not show V-shaped distortion of the extrahepatic ducts. No stones, strictures, or masses were identified, contributing to diagnostic uncertainty.

How did MRCP and DWI change the diagnosis?

MRCP confirmed the “whirl sign” involving the cystic duct and artery, and DWI demonstrated diffusion restriction in the gallbladder wall, consistent with acute ischemia secondary to torsion.

Sep 29, 2026

Uploaded by James